Clinical Use of Super Bioavailable Itraconazole for the Management of Dermatophytosis: Consensus Statement by Dermatologists from India via the Modified Delphi Technique

INTRODUCTION

Super bioavailable itraconazole (SB ITZ) overcomes the limitations of conventional itraconazole (CITZ) such as inter-individual variability and reduced bioavailability. It has been approved for systemic mycoses in Australia and Europe as 50mg and the United States as 65mg and in India as 50mg, 65mg, 100mg, and 130mg. However, data on the ideal dose and duration of SB ITZ treatment in managing dermatophytosis is insufficient. This consensus discusses the suitability, dosage, duration of treatment, and relevance of using SB ITZ in managing dermatophytosis in different clinical scenarios.

METHODS

Sixteen dermatologists, (>15 years of experience in the field and ≥2 years clinical experience with SB ITZ) formed the expert panel. A modified Delphi technique was employed, and a consensus was reached if the concordance in response was >75%.

RESULTS

A total of 26 consensus statements were developed. The preferred dose of SB ITZ is 130mg once daily and if not tolerated, 65mg twice daily. The preferred duration for treating naïve dermatophytosis is 4-6 weeks and that for recalcitrant dermatophytosis is 6-8 weeks. Moreover, cure rates for dermatophytosis are a little better with SB ITZ than with CITZ with a similar safety profile as of CITZ. Better patient compliance and efficacy are associated with SB ITZ than with CITZ, even in patients with comorbidities and special needs such as patients with diabetes, extensive lesions, corticosteroid abuse, adolescents, and those on multiple drugs.

CONCLUSION

Expert opinions indicate that overall clinical experience with SB ITZ is better than that with CITZ.

Canine retraction and anchorage loss using self-ligating and conventional brackets with sliding mechanics: A split-mouth clinical study

OBJECTIVE

Appliance biocompatibility, orthodontic treatment efficiency and patient convenience are the major issues confronting contemporary orthodontic practice. Very few studies have been published till date regarding the efficiency of self-ligating brackets as against conventional brackets. Hence, the present study was planned to compare the rate of canine retraction between self-ligating and conventional brackets and to determine the amount of anchorage loss during canine retraction.

METHODS

The present clinical study was designed as a prospective, observational study comprising of 25 patients requiring first premolar extraction as a part of orthodontic treatment. Self-ligating and conventional brackets were bonded using a split-mouth study design randomly. Retraction of canines was done with 150 grams of force using Dontrix gauge with E-chains. The study was conducted in relation to upper arch only, while the rate of retraction was evaluated every 4 weeks for 3 months. Average rates of retraction in 3 months were calculated. For anchorage loss, an acrylic guide plug was used in mid-treatment cast (T0) and after 3 months of retraction (T3). The statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 17.0 (SPSS Inc., Chicago, IL, USA). Independent t-test was used to compare the means of the two variables studied, while Pearson's correlation coefficient was used to evaluate the correlation between the variables studied in the groups included. P < .05 was considered statistically significant.

RESULTS

The correlation coefficient between the average rate of canine retraction with self-ligating brackets vs. conventional brackets over a period of 3 months came out to be 0.6434, while on comparing the data in terms of anchorage loss over a period of 3 months, the respective correlation coefficient value was found to be 0.6659 with the results being statistically highly significant in either case (P < .001).

CONCLUSIONS

Self-ligating brackets showed double the amount of displacement compared to conventional brackets in some of the cases. Also, chair side time was significantly reduced with self-ligating brackets as against conventional brackets.

COVID-19 SAFETY MEASURES AND THEIR EFFECTS ON GAMBLING HABITS: AN INVESTIGATIVE STUDY

This study looked at the way COVID-19 was starting to affect gambling during first six weeks of emergency actions. The following factors were evaluated: the economic effect of COVID-19 on internet gambling, according to COVID-19, psychological issues, addiction to drugs, and risky gambling habits and intentions. Online survey with cross-sectional data of 2015 gamblers was conducted, with a subsample of 1048 people who gambled online (age 18 and older). Numerous metrics of correlation and probability ratio analyses were performed. The Issue of Gambling Intensity Index's extremely dangerous gamblers and those who have gambled online are more likely to engage in gambling online, according to the outcomes, even though there was an obvious transition toward physical gaming. The most predicted indicators for high-risk gamblers on the internet were moderate to severe depression and anxiety, reduced work weeks, convincing themselves to gamble by COVID-19, gambling under the effects of alcohol or cannabis, and dangerous gambling motivations related to psychological disorders, such as gambling to relieve anxiety and depressive disorders, chasing gambling damages, and trying to make money from gambling. This research has validated numerous risk connections associated with gambling risk, psychological issues, and substance use reported in previous studies on the worldwide recession and upcoming COVID-19-related investigations. In contrast to many other inquiries, the current research considers each component comprehensively. It offers more information on the risk factors associated with online gambling throughout the epidemic.

Polysulfide Rejection Strategy in Lithium-Sulfur Batteries Using an Ion-Conducting Gel-Polymer Interlayer Membrane

Lithium-sulfur batteries (LiSBs) are emerging as promising alternative to conventional secondary lithium-ion batteries (LiBs) due to their high energy density, low cost, and environmental friendliness. However, preventing polysulfide dissolution is a great challenge for their commercial viability. The present work is focused on preparing a lithium salt and ionic liquid (IL) solution (SIL) impregnated ion (lithium ion)-conducting gel-polymer membrane (IC-GPM) interlayer to prevent polysulfide migration toward the anode by using an electrostatic rejection and trapping strategy. Herein, we introduce an SIL-based freestanding optimized IC-GPM70 (70 wt % SIL) interlayer membrane with high lithium-ion conductivity (2.58 × 10^-3 S cm^-1) along with excellent thermal stability to suppress the migration of polysulfide toward the anode and prevent polysulfide dissolution in the electrolyte. Because of the coulombic interaction, the anionic groups, -CF₂ of the β-phase polymer host PVdF-HFP, TFSI^- anion of IL EMIMTFSI, and anion BOB^- of LIBOB salt, allow hopping of positively charged lithium ions (Li⁺) but reject negatively charged and relatively large-sized polysulfide anions (S_x^-2, 4 <x <8). The cationic group EMIM⁺ of the IL is electrostatically able to attract and trap the polysulfides in the interlayer membrane. Since the shuttle effect of lithium polysulfides in LiSBs has been suppressed by the prepared IC-GPM70 interlayer, the resulting lithium-sulfur cell exhibits significantly higher cycling stability (1200 cycles), rate performance (1343, 1208, 1043, 875, and 662 mAh g^-1 at 0.1C, 0.2C, 0.5C, 1C, and 2C, respectively), and structural integrity during cycling than its counterpart without the IC-GPM70 interlayer. The interlayer membrane has been found to improve the performance and durability of LiSBs, thus making them a viable alternative to conventional LiBs.

Comparative Evaluation of Three Probiotics for Streptococcus mutans Prevention in Plaque Around Orthodontic Braces

BACKGROUND AND AIM

Orthodontic brackets can be a significant factor in enamel demineralization due to their complex structure, which makes brushing the teeth difficult and promotes the accumulation of food particles and dental plaque. The fact that metal braces have the highest surface tension and are more likely to cause enamel demineralization, which can result in the development of white spot lesions and enamel caries, is of critical significance to doctors, dentists, and patients. Probiotics have a beneficial effect in preventing and treating oral infectious diseases like tooth decay, gingival disorders, and bad breath. Research has shown that taking probiotics lowers the amount of Streptococcus mutans in the body. There has not been much research done to examine the results of administering a probiotic medication locally. This study was conducted to examine the effectiveness of three separate probiotics in the prevention of S. mutans accumulation in plaque surrounding orthodontic braces.

MATERIALS AND METHODS

A randomized controlled trial was conducted. The volunteers for each group were chosen using a straightforward random method. The sample size was 160 empirically determined subjects. They were divided as follows: study group 1 received probiotic lozenges (n=40). Study group 2 received probiotic sachets (n=40). Study group 3 received probiotic beverages (n=40). Group 4 was the control group, those who did not get probiotics (n=40). The samples were then plated onto culture media to test for Streptococcus mutans. S. mutans colonies were counted using a computerized colony counter.

RESULTS

The mean values of colony forming units (CFU/mL) of S. mutans at baseline in the control group were 354±23.6, while they were 232±41.7 at the end of the observation duration. The difference was non-relevant statistically (p=0.793). The mean values of CFU/mL of S. mutans at baseline in the group taking probiotic lozenges were 358.7±39.93, while they were 57±10.12 at the end of the observation duration. The difference was relevant statistically (p=0.021). The mean values of CFU/mL of S. mutans at baseline in the group taking probiotic sachets were 321.36±41.67, while they were 215.5±22.66 at the end of the observation duration. The difference was relevant statistically (p=0.043). The mean values of CFU/mL of S. mutans at baseline in the group taking the probiotic drink were 335.76±40.12, while they were 75.1±28.74 at the end of the observation duration. The difference was relevant statistically (p=0.032).

CONCLUSION

There was a significant decline in the number of colonies of S. mutans in all three forms of probiotics; however, the decline was greatest in the study participants taking probiotic lozenges.

Electrochemical performance of high valence Mo6+ and low valence Mn2+ doped- Na3V2(PO4)3@C cathode for sodium-ion batteries

Sodium superionic conductor (NASICON)-Na 3 V 2 (PO 4 ) 3 (NVP) is attractive cathode for sodium-ion battery, which is still confronted with limited rate performance due to its lower electronic conductivity. In this paper chemical strategy is adopted to partially replace V 3+ of NVP framework by low valence Mn 2+ and high valence Mo 6+ substitution. The crystal structure, sodium-ion diffusion coefficient and electrochemical performance of Mn-Mo-doped [Na 3.94 V 0.98 Mo 0.02 Mn(PO 4 ) 3 @C] cathode were investigated. X-ray diffraction confirmed the NASICON-type structure and XPS analysis confirmed the oxidation state of Mn and Mo in doped NVP cathode. The Na ion diffusion processes were inferred from Cyclic Voltammetry (CV), Galvanostatic intermittent titration technique (GITT) and Electrochemical Impedance Spectroscopy (EIS) measurement, which clearly show rapid Na-ion diffusion in NASICON-type cathode materials. The Mn-Mo-substituted NVP shows smoother charge-discharge profiles, improved rate performance (64.80 mAh/g at 1C rate), better energy density (308.61 mWh/g) and superior Na-ion kinetics than that of unsubstituted NVP@C cathode. Their enhanced performance is attributed to large interstitial volume mainly created by high valence Mo 6+ and enhanced capacity is attributed to the low valence Mn 2+ doping. These results demonstrate that Mn-Mo-doped NVP cathode is strongly promising cathode material for sodium-ion batteries.

Knowledge and Attitude of General Dentists and Non-Orthodontic Specialists Towards Early Orthodontic Treatment – A Cross-Sectional Analytical Study

Introduction: Malocclusion is one of the most important oral health problems among children and young adults, leads to social stigma and psychological disorders. Early detection of orthodontic disorders is essential in motivating patients to intervene prior to long-term complications when the disorders are not recognized. The aim of this study is to determine and evaluate the knowledge and attitude of general dentists and non-orthodontic specialists towards early orthodontic treatment. Materials and Method: A total of 240 dentists and other specialists than orthodontists participated in the study. A questionnaire consisting of 3 domains having 17 items was circulated using Google forms. The responses were collected further coded and analysed to assess the knowledge and attitude scores. Data was entered in SPSS (v.21.0) and statistical analysis was performed. (p<0.05) Result: A total of 122 general dentists and 122 non-orthodontic specialists responded to the questionnaire. The results showed that the non-orthodontic specialist had a higher mean knowledge score of 7.2 as compared to general dentists (6.1). Furthermore, both the study participants had a positive strong attitude towards improving their knowledge in early orthodontic treatment. Conclusion: The study highlights the need of better education for treatment concepts in orthodontics to the general dentist and non-orthodontic specialist.

Effect of micro-osteoperforations on the rate of orthodontic tooth movement and expression of biomarkers: a randomized controlled clinical trial

INTRODUCTION

Micro-osteoperforation is a minimally invasive technique that has been used to accelerate orthodontic tooth movement and reduce treatment duration. However, literature presents conflicting reports about this technique.

OBJECTIVE

To evaluate the effectiveness of micro-osteoperforations on the rate of canine retraction and expression of biomarkers in gingival crevicular fluid (GCF).

METHODS

This was a randomized clinical trial with split-mouth study design. Thirty adult subjects with age above 18 years (20.32 ± 1.96) who required fixed orthodontic treatment and extraction of maxillary first premolars were enrolled and randomly allocated to either the experimental or control group. Randomization was performed by block randomization method, with a 1:1 allocation ratio. The experimental group received three micro-ostoperforations (MOPs) distal to maxillary canine, using the Lance pilot drill. The retraction of maxillary canine was performed with NiTi coil-spring (150g) in both experimental and control groups. The primary outcome was the evaluation of canine retraction rate, measured on study models from the baseline to 16 weeks of canine retraction. Secondary outcomes were the estimation of alkaline and acid phosphates activity in GCF at 0, 1, 2, 3, and 4 weeks.

RESULTS

There was a statistically significant difference in the rate of canine retraction only after the first 4 weeks. Subsequently there was no statistically significant difference from the eighth to the sixteenth weeks between MOPs and control group. There was a statistically significant difference in alkaline and acid phosphates activity in GCF between MOPs and control groups during the initial 4 weeks of canine retraction.

CONCLUSION

Micro-ostoperforation increased the rate of tooth movement only for the first 4 weeks; thereafter, no effect was observed on the rate of canine retraction during 8, 12 and 16 weeks. A marked increase in biomarker activity in the first month was observed.

Abrogation of natural killer cell check point pathway LLT1/CD161 by novel anti LLT1 antibody ZM008 and its therapeutic applications in solid cancers

e14503

Background: LLT1/CD161 interaction plays important roles in cancer immune surveillance, fine tuning of NK cells responsiveness and down regulating effector functions. LLT1 gene expression was confirmed on multiple tumors as well as on various infiltrating immune cells. Therefore, it is relevant to develop therapeutic monoclonal antibody against LLT1 that could potentiate ADCC, ADCP, CDC, bispecific, CAR-T/NK functions to eliminate tumor cells. In this work, we have described discovery of novel human anti-LLT1 mAb ZM008, NK cells activation and anti-tumor function of ZM008. A Phase 1 open label, multicenter dose escalation clinical trial is planned in patients with advanced solid tumors to evaluate the safety and tolerability of ZM008, as monotherapy and in combination with Pembrolizumab. Methods: LLT1 gene expression was analyzed using TCGA database for 33 cancer indications. 60 Prostate cancer FFPE samples from Mt. Sinai hospital biorepository, NY were tested. Multiple in vitro studies were conducted to demonstrate the mode of action of ZM008 and efficacy was determined in HuNOG-EXL animals with PC3 xenograft. Cynomolgus monkeys were dosed with ZM008 (QW, 4 weeks) to understand the safety, pharmacokinetics, and toxicokinetics. Results: TCGA analysis revealed differential LLT1 gene expression in advance stages of NSCLC, TNBC, HNSCC, PRAD and urothelial cancers and high correlation with immune checkpoint pathways. HALO® data analysis of PRAD FFPE samples have shown distinct and strong signal on tumor cells with ZM008. Cell based assays with ZM008 revealed activation of CD69, NKG2D, CD107 and IFNγ on human NK cells leading to significant cytotoxicity of PC3 (MHC+ve) and K562 (MHC-ve) tumor cells. In vivo tumor growth inhibition was achieved at 10 mg/kg ZM008 treatment in HuNOG-PC3 xenograft tumor model. Anti-tumor function of ZM008 was demonstrated by high infiltration of CD8+ T cells and CD56+ NK cells in the TME. Cynomolgus study suggests ZM008 was well tolerated at 10 mg/kg and upto 125 mg/kg dosing with no mortality or adverse reactions. Half-life of ZM008 was determined up to 259 hours. Conclusions: This study for the first time revealed intense staining of LLT1 protein in high Gleason score prostate cancer, demonstrating therapeutic potential of ZM008 in solid cancers not responsive to current I/O checkpoint therapies. In vitro and in vivo experiments have shown human NK cells activation resulting in significant tumor growth reduction. CD56+ NK and CD8+ T cells infiltrations indicate transformation of “Cold tumors” to “Hot tumors”. Targeting LLT1/CD161 interaction in TME could stimulate robust NK and T cell mediated anti-tumor checkpoint functions. The ZM008 drug product is safe and well tolerated in Cynomolgus monkey safety and toxicity studies paving the way for the open-label, multicenter, Phase 1 dose-escalation study with ZM008. .

Adding to her woes: child bride's higher risk of hypertension at young adulthood

BACKGROUND

Child marriage is associated with various adverse socio-economic and pregnancy outcomes. However, there remains a dearth of research on the long-term health implications of child marriage. As such, this study sought to expand upon the growing literature on child marriage, specifically examining the associations between child marriage and hypertension during young adult age.

METHODS

We obtained data of 5369 women aged 20-34 from the Tajikistan Demographic and Health Survey 2017. Using multivariable logistic regression framework, we estimated the adjusted odds in favor of being hypertensive for women who were married before the age of 18. We also explored the presence of several stressors to understand the role of probable medication factors.

RESULTS

We found that the odds of being hypertensive for young adult women married before the age of 18 were 1.6 (95% confidence interval: 1.1-2.4) times that of those who were not. Likelihood of having stressors, such as pregnancy loss or child death, marital control and spousal violence, was found higher among child brides compared to their peers.

CONCLUSIONS

Findings suggest that child marriage may increase the risk of hypertension among young adult women. This work reinforces recommendations by the United Nations to the end child marriage.

Molecular detection of Salmonella isolated from commercial chicken

BACKGROUND

Salmonella in chicken, specially, the motile salmonellae, causes the food chain unsafe from farm to table and is considered a significant global threat to public health.

AIMS

The present study was carried out for molecular detection of Salmonellae in commercial poultry using PCR.

METHODS

The study was conducted for eight months, from July 2019 to February 2020, and a total of 26 poultry farms, including 15 broiler and 11-layer farms, were visited individually. Pooled faecal samples were obtained from the sheds. A total of 189 necropsy cases were examined for gastrointestinal lesions. Isolation and identification of the organism were done using microbe culture method, and the molecular characterization was performed via PCR targeting invA and ent genes.

RESULTS

The prevalence of salmonellosis in the broiler and layer farms was recorded at 20.0% and 45.4%, respectively, through the traditional gold standard culture method. From 189 necropsy birds, salmonellosis was recorded at 1.58% dead cases. Molecular detection of Salmonella isolates by PCR targeting invA gene was confirmed in 13.33% of the broiler farms and 36.3% of the layer farms. Further detection of Salmonella enteritidis was performed by PCR targeting ent gene by which 11.11% positivity was determined.

CONCLUSION

This study, focused on the Salmonella prevalence, highlighted the zoonotic importance of the bacterium in the commercial poultry farms, which can subsequently be dispersed into the human food chain causing harmful health effects.

Malaria, COVID-19 and angiotensin-converting enzyme 2: what does the available population data say?

The etiopathogenesis of COVID-19 and its differential geographic spread suggest some populations are apparently 'less affected' through many host-related factors that involve angiotensin-converting enzyme 2 (ACE2) protein, which is also the entry receptor for SARS-CoV-2. The role of ACE2 has been well studied in COVID-19 but not in the context of malaria and COVID-19. We have previously suggested how malaria might intersect with COVID-19 through ACE2 mutation and here we evaluate the currently available data that could provide a link between the two diseases. Based on the existing global and Indian data on malaria, COVID-19 and the suggested ACE2 mutation, the association could not be examined robustly, neither accepting nor refuting the suggested hypothesis. We strongly recommend targeted evaluation of this hypothesis through carefully designed robust molecular epidemiological studies.

POS1331 LONG-TERM OUTCOME IN CHILDREN WITH JUVENILE DERMATOMYOSITIS FROM SOUTHERN INDIA

Background:

There is paucity of data regarding long-term outcome and cumulative damage in children with juvenile dermatomyositis (JDM) from the Indian subcontinent.

Objectives:

To assess the long-term outcome and cumulative damage in children with JDM receiving treatment at a tertiary hospital in southern India.

Methods:

Retrospective review of records and cross-sectional assessment of outcome and damage in 29 patients with JDM at a tertiary hospital in Kochi, India. The disease course was categorized as monocyclic, polycyclic and chronic progressive. Cumulative damage was assessed using the IMACS myositis damage index (MDI).

Results:

Twenty-nine patients (male-16) diagnosed with definite or probable juvenile dermatomyositis based on the Bohan and Peter criteria and having a minimum follow-up period of 3 years each were enrolled. Of these, 20 children were diagnosed and initiated on treatment at our institute (inceptional) and 9 were diagnosed elsewhere and referred to our centre for further management (non-inceptional). The mean age at disease onset was 7.01 ± 3.34 years (range 1.0 to 13.5 years). The median interval from onset to diagnosis was 3 months (range- 3 weeks to 8.75 years). Delayed diagnosis defined as interval from onset to diagnosis exceeding 6 months was noted in case of 8 children. Among patients in the non-inceptional group, six were considered to have not received standard of care treatment prior to referral to our centre. Standard of care treatment was defined as initiation of a treatment regimen comprising of a combination of glucocorticoids with an immunosuppressive agent within 4 weeks of diagnosis. A total of 11 children had a delayed diagnosis and/or had not received standard of care treatment prior to referral.

At our centre, all patients received oral steroids and subcutaneous methotrexate as standard therapy. Pulse steroids were used to induce remission in 12 patients and as a rescue for relapses in 2 patients. Intravenous immunoglobulin was used in 10 children with severe myositis, oropharyngeal weakness, refractory cutaneous disease including calcinosis and concomitant infection, where affordable with good results. Hydroxychloroquine was added in 15 patients with dominant cutaneous manifestations. Mycophenolate mofetil, azathioprine and tacrolimus were used in patients refractory or intolerant to methotrexate. Cyclophosphamide and rituximab were used in 4 patients each with refractory disease and extra-muscular manifestations such as interstitial lung disease. Seven patients with refractory calcinosis received pamidronate infusions.

The total follow-up duration was 121.06 patient-years. A monocyclic course was observed in 11/29 (37.9%), chronic progressive course in 16/29 (55.2%) and polycyclic course in 2/29(6.9 %). Nearly half of the patients (14/29) had damage in at least one organ using the MDI (MDI ≥1). 38% of the patients (11/29) had at least one sign of cutaneous damage, the most common being calcinosis (n=11) and lipodystrophy (n=4). This was followed by skeletal damage (n=6, joint contractures-5, osteoporosis with fracture-1), muscle and pulmonary (pulmonary fibrosis) damage in 3 patients each, endocrine damage in 2 patients (diabetes mellitus-1, growth failure and delayed development of secondary sexual characteristics-1) and chronic infection in one patient. All patients with damage in at least one organ had a chronic progressive course, indicating damage accrual. Delayed diagnosis and lack of standard of care treatment prior to referral (i.e., longer duration of untreated/ sub-optimally treated disease) were associated with an increased risk of cumulative damage (p< 0.05).

Conclusion:

Nearly half of the patients had damage in at least one organ using the MDI. Cutaneous damage was the most common, followed by skeletal, muscle, pulmonary and endocrine damage. Longer duration of untreated/ sub-optimally treated disease significantly increases the risk of cumulative damage, highlighting the need for an early diagnosis and referral to pediatric rheumatology services.

Disclosure of Interests:

None declared

Impairment of olfactory and gustatory sensations in severe acute respiratory syndrome corona virus 2 (SARS-CoV-2 virus) disease

Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2 virus) disease had first appeared in December 2019 in Wuhan, China, and since then, it has emerged as a global threat to humanity. An early diagnosis and isolation are the most significant measures required to prevent its spread. Recent anecdotal evidence has suggested impairment of olfactory and gustatory sensations associated with corona virus disease (COVID-19). Angiotensin-converting enzyme-2 is an important aspect for the manifestations seen in this deadly viral disease. The associated olfactory and gustatory dysfunction can also lead to partial and/or complete loss of the ability to smell and taste in the early stages of disease onset. Evidence has also suggested that the presence of SARS-CoV-2 nucleic acid in human saliva makes it the carrier of the infectious viral disease and aids in its diagnosis. The present review focuses on the listed clinical manifestations in the form of olfactory and gustatory impairment in SARS-CoV-2 virus disease.

Should COVID-19 patients >75 years be Ventilated? An Outcome Study

BACKGROUND

Elderly patients with COVID-19 disease are at increased risk for adverse outcomes. Current data regarding disease characteristics and outcomes in this population are limited.

AIM

To delineate the adverse factors associated with outcomes of COVID-19 patients ≥75 years of age.

DESIGN

Retrospective cohort study.

METHODS

Patients were classified into mild/moderate, severe/very severe and critical disease (intubated) based on oxygen requirements. The primary outcome was in-hospital mortality.

RESULTS

A total of 355 patients aged ≥75 years hospitalized with COVID-19 between 19 March and 25 April 2020 were included.Mean age was 84.3 years. One-third of the patients developed critical disease. Mean length of stay was 7.10 days. Vasopressors were required in 27%, with the highest frequency in the critical disease group (74.1%). Overall mortality was 57.2%, with a significant difference between severity groups (mild/moderate disease: 17.4%, severe/very severe disease: 71.3%, critical disease: 94.9%, P < 0.001).Increased age, dementia, and severe/very severe and critical disease groups were independently associated with increased odds for mortality while diarrhea was associated with decreased odds for mortality (OR: 0.12, 95% CI: 0.02-0.60, P < 0.05). None of the cardiovascular comorbidities were significantly associated with mortality.

CONCLUSION

Age and dementia are associated with increased odds for mortality in patients ≥75 years of age hospitalized with COVID-19. Those who require intubation have the greatest odds for mortality. Diarrhea as a presenting symptom was associated with lower odds for mortality.

POS1262 A COHORT STUDY OF COVID-19 RELATED MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN AND ADOLESCENTS FROM MULTIPLE TERTIARY CARE CENTRES IN SOUTH INDIA

Background:

After the peak of COVID 19 pandemic, a surge of cases with multi-system involvement and hyperinflammatory state was reported in children, at multiple tertiary care centers across the world. (1) This COVID-19 associated multisystem inflammatory syndrome in children and adolescents is also known as multisystem inflammatory syndrome in children (MIS-C). There is a paucity of literature of clinical profile of MIS-C patients from India.

Objectives:

To study the clinical manifestations and treatment outcomes of COVID-19 related multisystem inflammatory syndrome in children (MIS-C) and adolescents.

Methods:

It was a cohort study including cases defnied as per the case definitions of MIS-C by World Health Organisation (WHO) or Centre for Disease Control and Prevention(CDC).(2)The clinical parameters, laboratory parameters (including inflammatory markers, D dimer and NT ProBNP), electrocardiogram, 2D echocardiogram, course in hospital, and immediate outcomes were noted.

Results:

Twenty five patients (male-14) with a mean age of 6.22 ±4.25 years and a mean body mass index of 16.21 ±3.36 kg/m2 were enrolled on the study. Average length of hospital stay was 8.12±5.76 days. Associated comorbidities were present in 4 of our patients (16%). Figure 1 shows the frequency of clinical features in our study patients. Table 1 shows the clinical, laboratory, imaging findings, disease course and outcomes.

Figure 1.

Frequency of clinical features in our MIS-C cohort patients

Table 1.

Clinical characteristics of MIS-C patients (n)=25

Clinical Phenotypes:Incomplete/ Atypical Kawasaki Disease (KD)18 (72%)Macrophage activation syndrome (MAS)11 (44%)Unexplained Shock13 (52%)Fever with gastrointestinal symptoms17 (68%)Fever with neurological symptoms9 (36%)Fever with respiratory symptoms5 (20%)COVID chronology:MISC with acute COVID 19 with MAS1 (4%)MISC with acute COVID 19 with incomplete/atypical KD1 (4%)COVID 19 tests:COVID 19 RTPCR positive2 (8%)COVID 19 RTPCR negative23 (92%)COVID 19 IgG positive20 (80%)COVID 19 IgM positive6 (24%)COVID 19 IgG and IgM both positive2 (8%)COVID 19 IgG and IgM not done4 (16%)Other laboratory investigations(Peak/ trough values):Anaemia20 (80%)Leukopenia2 (8%)Thrombocytopenia6 (24%)Pancytopenia2 (8%)Positive CRP23 (92%)High Procalcitonin9 (36%)High ferritin10 (40%)High D- dimer17 (68%)High NT ProBNP23 (92%)Hypoalbuminemia14 (56%)Sterile pyuria7 (28%)Proteinuria4 (16%)Cardiac assessment:Abnormal Electrocardiogram (ECG)5 (20%)Abnormal Echocardiography15 (60%)Coronary dilation/prominence/non-tapering9 (36%)Coronary aneurysm1 (4%)LAD Z score (Mean±SD)2.12 ± 1.11Decreased Ejection fraction (EF)5 (20%)Systolic Dysfunction5 (20%)Pericardial effusion9 (36%)Global/septal hypokinesia4 (16%)Mitral Valve regurgitation3 (12%)Complete heart block1 (4%)

Twenty patients (80%) had severe illness requiring intensive care. Fourteen patients (56%) required inotropic support, 8 patients (32%) required supplemental oxygen, 5 patients (20%) required mechanical ventilation and 2 patients (8%) expired. A total of 23 patients (92%) received pulse steroids followed by oral/iv steroids, 22 patients (88%) received IVIG (2g/kg) and 3 patients (12%) required anticoagulation.

Conclusion:

Our MIS-C cohort had varied clinical manifestations ranging from the mild cutaneous and gastrointestinal symptoms to fatal multiorgan dysfunctions. In contrast to western cohorts, our study cohort had higher number of patients from younger age group and lower BMI.

References:

[1]Ahmed M, Advani S, Moreira A, Zoretic S, Martinez J, Chorath K et al. Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine. 2020;26:100527.

[2]Jiang L, Tang K, Levin M, Irfan O, Morris S, Wilson K et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents. The Lancet Infectious Diseases. 2020;20(11):e276-e288.

Disclosure of Interests:

None declared

Cerebral Venous Thrombosis in COVID-19: A New York Metropolitan Cohort Study

BACKGROUND AND PURPOSE

Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection is associated with hypercoagulability. We sought to evaluate the demographic and clinical characteristics of cerebral venous thrombosis among patients hospitalized for coronavirus disease 2019 (COVID-19) at 6 tertiary care centers in the New York City metropolitan area.

MATERIALS AND METHODS

We conducted a retrospective multicenter cohort study of 13,500 consecutive patients with COVID-19 who were hospitalized between March 1 and May 30, 2020.

RESULTS

Of 13,500 patients with COVID-19, twelve had imaging-proved cerebral venous thrombosis with an incidence of 8.8 per 10,000 during 3 months, which is considerably higher than the reported incidence of cerebral venous thrombosis in the general population of 5 per million annually. There was a male preponderance (8 men, 4 women) and an average age of 49 years (95% CI, 36-62 years; range, 17-95 years). Only 1 patient (8%) had a history of thromboembolic disease. Neurologic symptoms secondary to cerebral venous thrombosis occurred within 24 hours of the onset of the respiratory and constitutional symptoms in 58% of cases, and 75% had venous infarction, hemorrhage, or both on brain imaging. Management consisted of anticoagulation, endovascular thrombectomy, and surgical hematoma evacuation. The mortality rate was 25%.

CONCLUSIONS

Early evidence suggests a higher-than-expected frequency of cerebral venous thrombosis among patients hospitalized for COVID-19. Cerebral venous thrombosis should be included in the differential diagnosis of neurologic syndromes associated with SARS-CoV-2 infection.

Unconventional Transverse Transport above and below the Magnetic Transition Temperature in Weyl Semimetal EuCd_{2}As_{2}

As exemplified by the growing interest in the quantum anomalous Hall effect, the research on topology as an organizing principle of quantum matter is greatly enriched from the interplay with magnetism. In this vein, we present a combined electrical and thermoelectrical transport study on the magnetic Weyl semimetal EuCd_{2}As_{2}. Unconventional contribution to the anomalous Hall and anomalous Nernst effects were observed both above and below the magnetic transition temperature of EuCd_{2}As_{2}, indicating the existence of significant Berry curvature. EuCd_{2}As_{2} represents a rare case in which this unconventional transverse transport emerges both above and below the magnetic transition temperature in the same material. The transport properties evolve with temperature and field in the antiferromagnetic phase in a different manner than in the paramagnetic phase, suggesting different mechanisms to their origin. Our results indicate EuCd_{2}As_{2} is a fertile playground for investigating the interplay between magnetism and topology, and potentially a plethora of topologically nontrivial phases rooted in this interplay.

Patient Behavioral Analysis with Smart Healthcare and IoT

Patient behavioral analysis is the key factor for providing treatment to patients who may suffer from various difficulties including neurological disease, head trauma, and mental disease. Analyzing the patient's behavior helps in determining the root cause of the disease. In traditional healthcare, patient behavioral analysis has lots of challenges that were much more difficult. The patient behavior can be easily analyzed with the development of smart healthcare. Information technology plays a key role in understanding the concept of smart healthcare. A new generation of information technologies including IoT and cloud computing is used for changing the traditional healthcare system in all ways. Using Internet of Things in the healthcare institution enhances the effectiveness as well as makes it more personalized and convenient to the patients. The first thing that will be discussed in the article is the technologies that have been used to support the smart class, and further, there will be a discussion on the existing problems with the smart healthcare system and how these problems can be solved. This study can provide essential information about the role of smart healthcare and IoT in maintaining behavior of patent. Various biomarkers are maintained properly with the help of these technologies. This study can provide effective information about importance of smart health system. This smart healthcare is conducted with the involvement of proper architecture. This is treated as effective energy efficiency architecture. Artificial intelligence is used increasingly in healthcare to maintain diagnosis and other important factors of healthcare. This application is also used to maintain patient engagement, which is also included in this study. Major hardware components are also included in this technology such as CO sensor and CO₂ sensor.

Cylinder-flat-surface contact mechanics during sliding

Using molecular dynamics we study the dependency of the contact mechanics on the sliding speed when an elastic block (cylinder) with a cos(q_{0}x) surface height profile is sliding in adhesive contact on a rigid flat substrate. The atoms on the block interact with the substrate atoms by Lennard-Jones potentials, and we consider both commensurate and (nearly) incommensurate contacts. For the incommensurate system the friction force fluctuates between positive and negative values, with an amplitude proportional to the sliding speed, but with the average close to zero. For the commensurate system the (time-averaged) friction force is much larger and nearly velocity independent. For both types of systems the width of the contact region is velocity independent even when, for the commensurate case, the frictional shear stress increases from zero (before sliding) to ≈0.1MPa during sliding. This frictional shear stress, and the elastic modulus used, are typical for polydimethylsiloxane rubber sliding on a glass surface, and we conclude that the reduction in the contact area observed in some experiments when increasing the tangential force must be due to effects not included in our model study, such as viscoelasticity or elastic nonlinearity.

Craniofacial morphology of HIV-infected adolescents undergoing highly active antiretroviral therapy (HAART): An original research

OBJECTIVES:

To analyze the craniofacial morphology in child patients and adolescents by evaluating the skeletal cephalometric profile of the HIV infected patients in this age group and comparing them with the HIV-negative controls.

MATERIALS AND METHODS:

The present study was a planned case-control study which included 25 HIV-positive adolescent patients aged between 10 and 18 years (the study group) who were compared with 25 age- and sex-matched HIV-negative adolescent controls (the control group). All the patients had been HIV infected via a vertical transmission with positive serology confirmed in two different tests and had been kept on HAART since they were born. The diagnostic aids used for orthodontic documentation included facial photographs, digital orthopantomographs, lateral teleradiographs, and study models.

RESULTS:

With reference to the methodologies used for taking the cephalometric values, all the methods used were in strong agreement with each other for almost all the variables studied and had high intra-class correlation coefficient values except Co-A, SN.ANSPNS, and SNB which, too, had a good agreement of 60%. Nevertheless, the agreement was positive for these variables, too, since the P values obtained were found to be statistically significant (P < 0.05).

CONCLUSION:

Most of the measurements in the HIV-infected adolescents were found to be similar to the ones obtained for the HIV-negative controls, although, the study results highlighted the significance of further studies to be conducted in this regard, especially, the longitudinal study designs wherein the said variables can be studied on a follow-up basis in longitudinal studies to have an idea of the exact changes observed and their pattern in the included groups.

Adhesion paradox: Why adhesion is usually not observed for macroscopic solids

The adhesion paradox refers to the observation that for most solid objects no adhesion can be detected when they are separated from a state of molecular contact. The adhesion paradox results from surface roughness, and we present experimental and theoretical results that show that adhesion in most cases is "killed" by the longest-wavelength roughness. In addition, adhesion experiments between a human finger and a clean glass plate were carried out, and for a dry finger no macroscopic adhesion occurred. We suggest that the observed decrease in the contact area with increasing shear force results from nonadhesive finger-glass contact mechanics, involving large deformations of complex layered material.

Deep Transfer Learning Based Classification Model for COVID-19 Disease

The COVID-19 infection is increasing at a rapid rate, with the availability of limited number of testing kits. Therefore, the development of COVID-19 testing kits is still an open area of research. Recently, many studies have shown that chest Computed Tomography (CT) images can be used for COVID-19 testing, as chest CT images show a bilateral change in COVID-19 infected patients. However, the classification of COVID-19 patients from chest CT images is not an easy task as predicting the bilateral change is defined as an ill-posed problem. Therefore, in this paper, a deep transfer learning technique is used to classify COVID-19 infected patients. Additionally, a top-2 smooth loss function with cost-sensitive attributes is also utilized to handle noisy and imbalanced COVID-19 dataset kind of problems. Experimental results reveal that the proposed deep transfer learning-based COVID-19 classification model provides efficient results as compared to the other supervised learning models.

P268 Anomalies of pulmonary arteries in Tetralogy of Fallot in developing countries: study of 100 cases in indian population

Introduction

Right ventricular outflow tract (RVOT) obstruction in some or other form is one of the major components of Tetralogy of Fallot. It can occur at any level, isolated or in combination, from Infundibulum (most common), Pulmonary valve, Main pulmonary artery, Right and Left pulmonary arteries and up to their segmental branches. Incidence of pulmonary artery anomalies are reported between 15-20%, though some reported as high as 40%. 

Purpose

 The objective of this retrospective  observational study is to determine the presence and degree of pulmonary artery  abnormalities and associated cardiac defects in patients with Tetralogy of Fallot and to  define the pulmonary arterial anatomy to guide the further surgical management.

Method

A total of 100 newly diagnosed or follow up cases of TOF irrespective of age (range 5 days- 32 years) and gender (32 female, 68 male) who were planned for surgical management and referred for evaluation of pulmonary artery anatomy. All patient underwent non-ECG gated CT pulmonary Angiography in Toshiba 64 slice CT scanner.  CT data was analyzed retrospectively to look for cardiac and pulmonary artery anatomy by one independent observer having experience in cardiac radiology.

Results

92 patient had infundibular and valvular stenosis and 8 patients has atretic pulmonary valve with additional supravalvar pulmonary stenosis in 17% patient. Out of total 100 patients, 35% had pulmonary artery abnormalities. This included 19 patient (19%) with isolated main pulmonary artery (MPA) abnormality, 6 % had isolated left pulmonary artery (LPA) abnormality, 2 had isolated right pulmonary artery abnormality, 4% had  combined MPA and LPA  abnormality, 2% had combined MPA and RPA abnormalities and 1% patient had all 3 (MPA,LPA,RPA) involvement in form of stenosis or hypoplasia. As TOF is commonly associated with other cardiac structural anomalies, we encountered following associations in our study – aortopulmonary collaterals (37%), Patent ductus arteriosus (29%), right sided aortic arch (19%), bilateral superior vena cava (10%), bovine arch (3%), double aortic arch (2%), d malposition of great vessels (2%), l malposition of great vessels (1%), situs inversus (1%), dextrocardia (1%), annuloaortic ectasia (1%) aortopulmonary window (1%) and cardiac totally anomalous pulmonary venous connection (1%).

Conclusions

Anomalies of pulmonary arteries are important determinant of surgical outcome of TOF patients. CT angiography is now established modality to delineate pulmonary artery and other anatomical details in TOF patient. Pulmonary artery anomaly can range from isolated branch pulmonary stenosis to diffuse hypoplasia of pulmonary vasculature, based on which management can differ from complete correction to palliative or medical management only. Our study emphasize the importance of pulmonary artery evaluation and its variation among patients of TOF.

Abstract P268 Figure.

Accurate calculation of zero point energy from molecular dynamics simulations of liquids and their mixtures

The two-phase thermodynamic (2PT) method is used to compute the zero point energy (ZPE) of several liquids and their mixtures. The 2PT method uses the density of states (DoS), which is computed from the velocity autocorrelation (VAC) function obtained from a short classical molecular dynamics trajectory. By partitioning the VAC and the DoS of a fluid into solid and gaslike components, quantum mechanical corrections to thermodynamical properties can be computed. The ZPE is obtained by combining the partition function of the quantum harmonic oscillator with the vibrational part of the solidlike DoS. The resulting ZPE is found to be in excellent agreement with both experimental and ab initio results. Solvent effects such as hydrogen bonding and polarization can be included by the utilization of ab initio density functional theory based molecular dynamics simulations. It is found that these effects significantly influence the DoS of water molecules. The obtained results demonstrate that the 2PT model is a powerful method for efficient ZPE calculations, in particular, to account for solvent effects and polarization.

A case report of carcinoma of uterine cervix throwing heterochronous metastasis to the skin, spleen, and pancreas: the role of multimodality treatment approach

BACKGROUND

Cancer of cervix often fails locally and/or within the pelvis. One to two percent of cervical squamous cell carcinoma patients have lung metastases at presentation, and 5-35% develop pulmonary metastases later on. Common sites of metastases are the liver, bone, and bowel. We report a rare case presentation of cervical squamous cell cancer where heterochronous metastasis occurred in the skin, spleen, and pancreas without loco-regional recurrence and skipping of visceral organs such as the lung, liver, and brain.

CASE PRESENTATION

A 55-year-old, postmenopausal lady presented with a complaint of bleeding of the vagina for 2 months duration. Cervical biopsy revealed squamous cell carcinoma of the cervix, and she was staged as a case of FIGO stage IIIB. She received external beam-beam radiotherapy of 50 Gy in 25 fractions along with concurrent weekly cisplatin at 35 mg/m² followed by 3 fractions of intracavitary brachytherapy of 6 Gy each. After 30 months of follow-up, she presented with a skin lesion of 6 × 5 cm² in the infrascapular region for 2 months duration. Biopsy revealed metastatic squamous cell carcinoma. Her metastatic work-up revealed no other lesions. Palliative radiotherapy to local site of 8 Gy in single fraction was delivered. The lesion disappeared within 4 weeks. She was given 6 cycles of cisplatin and paclitaxel salvage chemotherapy. After 30 months of follow-up, she presented with a skin lesion of 6 × 5 cm² in the infrascapular region. Biopsy revealed metastatic squamous cell carcinoma. Her metastatic work-up revealed no other lesions. Palliative radiotherapy to the local site was planned, and a dose of 8 Gy in a single fraction was delivered. The lesion disappeared within 4 weeks. She was given 6 cycles of cisplatin and paclitaxel salvage chemotherapy. Six months after the completion of salvage therapy, she reported with the complaints of recurrent bouts of hematemesis and melena. Her CECT scan revealed 2 × 1.5 cm² growth in the body of the pancreas and a subcentric splenic hilum node. She underwent open splenectomy with distal pancreatectomy. Histopathology report showed metastatic infiltration in pancreatic tissue by squamous cell carcinoma and one metastatic node in the splenic hilum. Post-treatment, 6 months, the patient was asymptomatic with no recurrence.

CONCLUSIONS

This is a rare heterochronous metastatic presentation of cervical cancer without loco-regional recurrence and visceral organs such as the lung, liver, and brain. The optimal treatment remains undefined for these patients. Multimodality treatment is necessary to manage the patients.

Physics of suction cups

We have developed a theory of air leakage at interfaces between two elastic solids with application to suction cups in contact with randomly rough surfaces. We present an equation for the airflow in narrow constrictions which interpolates between the diffusive and ballistic (Knudsen) air-flow limits. To test the theory, we performed experiments using two different suction cups, made from soft polyvinylchloride (PVC), in contact with sandblasted polymethylmethacrylate (PMMA) plates. We found that the measured time to detach (lifetime) of the suction cups was in good agreement with theory, except for surfaces with a root-mean-square (rms) roughness below ≈1 μm, where diffusion of plasticizer from the PVC to the PMMA surface caused blockage of critical constrictions. The suction cup volume, stiffness, and elastic modulus have a huge influence on the air leakage and hence the failure time of the cups. Based on our research we propose an improved biomimetic design of suction cups that could show improved failure times with varying degrees of roughness under dry and wet environments.

Rolling friction of elastomers: role of strain softening

We study the temperature and velocity dependency of rolling friction. Steel and PMMA cylinders are rolled on sheets of nitrile butadiene rubber (NBR), with and without filler, and fluoroelastomer (FKM) with filler. Measurements of the rolling friction are performed for temperatures between -40 °C and 20 °C, and for velocities between 5 μm s^-1 and 0.5 cm s^-1. For the unfilled NBR, a smooth rolling friction master curve is obtained using the bulk viscoelastic frequency-temperature shift factor a_T. For the filled rubber compounds, a small deviation from the bulk viscoelastic shift factor is observed at low temperatures. The experimental data are analyzed using an analytical theory of rolling friction. For the filled compounds, good agreement with theory is obtained when strain softening is included, which increases the rolling friction by a factor ∼2 for the filled FKM and ∼3 for the filled NBR compounds. For the unfilled NBR, the maximum of the rolling friction occurs at higher sliding speeds than predicted by the theory. We discuss the role of the adhesive (crack-opening) contribution to the rolling friction, and the role of frozen-in elastic deformations as the rubber is cooled down below the rubber glass transition temperature.

Unusual presentation of chondroblastoma mimicking Trevor's disease

Chondroblastoma is a benign bone tumor, represents 1%–2% of all primary bone tumors, typically seen in patients 10–25-year-old and more common in males. It occurs most frequently in the distal femur, proximal tibia, and proximal humerus. Soft tissue extension is extremely rare. Adjacent joints may develop effusions, but the tumor mass protruding into the joint has never been seen in case of chondroblastoma. We report a rare case of intra-articular chondroblastoma arising from proximal tibia in a 16-year-old boy and growing into the knee joint mimicking an intra-articular osteochondroma.

Wilson's disease: A new perspective review on its genetics, diagnosis and treatment

Wilson's disease (WD) is an autosomal recessive disorder which is caused by poor excretion of copper in mammalian cells. In this review, various issues such as effective characterization of ATP7B genes, scope of gene network topology in genetic analysis, pattern recognition using different computing approaches and fusion possibilities in imaging and genetic dataset are discussed vividly. We categorized this study into three major sections: (A) WD genetics, (B) diagnosis guidelines and (3) treatment possibilities. We addressed the scope of advanced mathematical modelling paradigms for understanding common genetic sequences and dominating WD imaging biomarkers. We have also discussed current state-of-the-art software models for genetic sequencing. Further, we hypothesized that involvement of machine and deep learning techniques in the context of WD genetics and image processing for precise classification of WD. These computing procedures signify changing roles of various data transformation techniques with respect to supervised and unsupervised learning models.

Novel monoclonal antibody therapeutics for metastatic castration resistant prostate cancer

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Background: Therapeutic potential of innate immunity comprising Natural killer cell based targets are beginning to unravel the complexity of immune responses. NK cells recognize and induce cytotoxicity of wide range of target cells, such as, tumor cells without prior antigen sensitization. In this study, we have studied Lectin-like transcript 1 (LLT1), a member of the C-type lectin super family, is expressed on target cells and various immune cells. LLT1 isoform 1, is known to interact with CD161, a critical receptor on NK cells. CD161 is expressed on most of human NK cells, NK-T cells, γδ T cells and so on. Tumors exploit the CD161- LLT1 interaction to evade host defense mechanism (“DO NOT KILL” signal); indicating LLT1 as an attractive immunotherapeutic strategy. Methods: Prostate cancer cell lines and other tumor cell lines were used to evaluate novel anti LLT1 antibodies for therapeutic potential - IFNγ production assays and tumor cell death assays were carried out. In vivo efficacy of these antibodies were established using PC3 xenograft in humanized mouse model (HuNOG-EXL). Results: Human androgen independent prostate cancer cell line, PC3 was studied for LLT1 expression and interactions with immune cells, to understand role of LLT1 in metastatic castration resistant prostate cancer (mCRPC). Overexpression of LLT1 on tumor cells was influenced by cytokines and various TLRs. Inhibition of CD161-LLT1 interaction with novel anti LLT1 antibodies leads to IFNγ production and consequent NK cell mediated cytotoxicity – hall mark of anti-tumor responses. Disruption of LLT1 - CD161 innate immunity axis with anti LLT1 antibody releases the break on NK cell cytotoxicity and hence, established a new therapeutic option. PC3 xenograft on HuNOG mouse revealed in vivo efficacy of LLT1 antibody. Significant tumor growth reduction was observed with specific anti LLT1 antibodies alone and in combination with check point antibodies. Thus, synergistic tumor growth reduction was established by combinatorial application of anti LLT1 antibody and PD1/PDL1 axis inhibitors. Conclusions: PC3 xenograft study and other results point to therapeutic opportunities in metastatic castration resistant prostate cancer, a disease condition which needs improved patient outcomes. The ligation of CD161/LLT1 will serve as a new immuno-oncology pair regulating innate and adaptive immune responses; novel human antibodies against LLT1 described here will bring therapeutic benefit to patients in need.

Vitamins for Cancer Prevention and Treatment: An Insight

Over a few decades a strong interlink between oxidative damage and cancer has been investigated by various scientists across the world on the basis of epidemiological observations of the effects of fruits and vegetables used in the diet for cancer patients. Primarily, Vitamin C, Vitamin D and Vitamin E are reported to be involved in the amelioration of side effects which occur in chemotherapy and radiation therapy of lungs, stomach, prostate, colorectal, gastric head and neck cancers. The vitamins acting as antioxidant adjuvants are found to have apoptotic and antiangiogenesis potential as well as inhibitory effects against metastasis in cancer cells. This chapter explicitly discusses the key aspects concerned with the vitamins in relation to cancer prevention and treatment. It describes vitamins and their natural resources, role of vitamins in the body, and vitamins as prime ingredients in the diet and their effects on cancer biology with reference to recent research reports. Moreover, this paper also includes the emerging potential of pharmaceutical advances to enhance bioavailability of the vitamins to cancer patients with improved safety and efficacy. Clinicians and researchers must mull over the nutritional requirements of individual cancer patient so as to treat cancer and increase life expectancy.