Immune-compromising Conditions Research Articles

Real-world clinical outcomes of tixagevimab/cilgavimab in the Omicron outbreak in China: baseline characteristics and interim analysis of the CLEAR study

PurposeThis study aimed to investigate the real-world use and clinical outcomes of tixagevimab/cilgavimab in China during the Omicron outbreak in late 2022.MethodsThis observational, real-world study included patients who received tixagevimab/cilgavimab from July 9 to December 30, 2022, in Hainan, China. Here, we report the baseline and characteristics and interim analysis results of the clinical outcomes in those receiving at least one dose of tixagevimab/cilgavimab (300 mg) for pre-exposure prophylaxis.ResultsAmong 248 subjects who received tixagevimab/cilgavimab, 229 subjects were included in this analysis. Until March 28, 2023, the median follow-up was 95 days. The mean age of the subjects was 44.4 ± 15.9 years, 11.8% were ≥ 65 years, and 41.5% were male. Fifty-eight (25.3%) subjects had comorbidities, 16.2% subjects had key immune compromised conditions. Seventy-two (32.6%) patients had laboratory-confirmed SARS-CoV-2 infection and/or received healthcare within three months; 71/72 (98.6%) had mild disease, and one (1.4%) was moderate. No COVID-19-related intensive care unit (ICU) admissions, extracorporeal membrane oxygenation utilizations, or death occurred. Two (0.9%) patients required hospitalization. One (0.4%) serious adverse event occurred, which was considered unrelated to tixagevimab/cilgavimab.ConclusionAmong Chinese patients receiving prophylactic tixagevimab/cilgavimab, the incidence of COVID-19-related hospitalization, ICU admission, or death was low during the Omicron surge. Further randomized controlled trials with larger sample sizes are needed to determine the effectiveness of tixagevimab/cilgavimab in preventing severe COVID-19 outcomes.Trial registrationThe study was registered with clinicaltrial.gov (NCT05917951).

Leveraging a clinical emergency department dataset to estimate two-dose COVID-19 vaccine effectiveness and duration of protection in Canada

BackgroundDuring the COVID-19 pandemic, clinical care shifted toward virtual and Emergency Department care. We explored the feasibility of mRNA vaccine effectiveness (VE) estimation against SARS-CoV-2-related Emergency Department visits and hospitalizations using prospectively collected Emergency Department data. MethodsWe estimated two-dose VE using a test-negative design and data from 10 participating sites of the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). We included Emergency Department patients presenting with COVID-19 symptoms and nucleic acid amplification testing for SARS-CoV-2 between July 19 and December 31, 2021. We excluded patients with unclear vaccination and one or more than 2 vaccine doses by their Emergency Department visit. ResultsAmong 3,405 eligible patients, adjusted two-dose mRNA VE against SARS-CoV-2-related Emergency Department visits was 93.3 % (95 % CI 87.9–96.3 %) between 7–55 days, sustained over 80 % through 139 days post-vaccination. In stratified analyses, VE was similar among patients with select immune-compromising conditions, chronic kidney disease, lung disease, unstable housing, and reported illicit substance use. ConclusionsTwo-dose mRNA VE against SARS-CoV-2-related Emergency Department visit was high and sustained, including among vulnerable subgroups. Compared to administrative datasets, active Emergency Department enrolment enables standardization for testing access and indication and supports separate VE assessment among special population subgroups. Compared to other active enrolment settings, Emergency Departments more consistently function during crises when alternate healthcare sectors become variably closed.Trial registration: Clinicaltrials.gov, NCT0470294.

Controlled delivery of nikkomycin by PEG coated PLGA nanoparticles inhibits chitin synthase to prevent growth of Aspergillus flavus and Aspergillus fumigatus.

Aspergillosis is one of the most common fungal infections that can threaten individuals with immune compromised condition. Due to the increasing resistance of pathogens to the existing antifungal drugs, it is difficult to tackle such disease conditions. Whereas, nikkomycin is an emerging safe and effective antifungal drug which causes fungal cell wall disruption by inhibiting chitin synthase. Hence, the study aims at the development of nikkomycin loaded PEG coated PLGA nanoparticles for its increased antifungal efficiency and inhibiting Aspergillus infections. The P-PLGA-Nik NPs were synthesized by w/o/w double emulsification method which resulted in a particle size of 208.3±15 nm with a drug loading of 52.97 %. The NPs showed first order diffusion-controlled drug release which was sustained for 24 h. These nanoparticle's antifungal efficacy was tested using the CLSI- M61 guidelines and the MIC50 defined against Aspergillus flavus and Aspergillus fumigatus was found to be >32 μg/ml which was similar to the nikkomycin MIC. The hyphal tip bursting showed the fungal cellwall disruption. The non-cytotoxic and non-haemolytic nature highlights the drug safety profile.

Sprayable biogenic Ag-collagen nanocomposites with potent antibacterial and antibiofilm activity for Acinetobacter baumannii infected wound healing under hyperglycemic condition

Owing to their susceptibility to infection by drug-resistant bacteria, refractory wounds pose a formidable risk to the well-being of patients with diabetes and other immune-compromised conditions, and their management poses significant economic distress to the healthcare system, particularly in low and middle-income countries. Therefore, deployable interventions for rapid and effective management of such wounds are needed. In the present study, we report the processing of sprayable biogenic Ag-collagen nanocomposites (Ag-Col NCs) with cogent antibacterial and healing activity in Acinetobacter baumannii infected wounds under hyperglycemic conditions. Silver nanoparticles (Ag NPs) has been synthesized by using the plant extract of Urginea indica (U. indica), which was further used for the processing of Ag-Col NCs. Synthesized NCs were found to have notable broad spectrum antibacterial activity against clinically significant strains (Acinetobacter baumannii, Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus) and appreciable biocompatibility towards RAW 264.7 and 3 T3 mouse fibroblast cell lines. The sprayable NC system was found to promote the wound healing activity in mouse model (Balb/c) not only in normal but also in hyperglycemic conditions. Our experimental findings suggest the potential of the Ag-Col NC spray in chronic wound management and an exploitable option in both clinical and personalized settings.

Management of asthma using probiotics

Asthma is one of the most common respiratory diseases in humans throughout the world. The illness continues to be the most prevalent cause of respiratory morbidity and affects both adults and children. Asthma is mainly caused by microbes, especially the species of Aspergillus. It causes continuous irritation and distracts the mental attention of the patient, leading to physical weakness and depression resulting in immune-compromised conditions. Asthmatic patients need careful attention and continuous treatment. Taking into account its major effects on patients’ quality of life, the challenging nature of the therapy, and side effects of the novel therapeutic strategies that influence the clinical course of asthma are required to be considered before finally deciding the course of treatment. Children with asthma and wheezing are frequently sustained by a type-2 immune response. In addition, people with wheezing and asthma can be identified by the presence of digestive and respiratory tract dysbiosis. Therefore, oral probiotics could be used as an additional asthmatic medication to manage asthma, but the decision should be constantly monitored by specialized persons. During the last two decades, the importance of probiotics in the treatment of various ailments has been realized and several researches are being conducted to find out the impact of healthy gut microbiome on the management of various diseases including asthma.

A Case Study – Surgical Site Infection of Open Fracture Grade II Caused by Pseudomonas aeruginosa

Introduction: Surgical Site Infections (SSI) are the third most commonly reported nosocomial infections which has an adverse impact on the hospital as well as on the patient. SSI a hospital acquired infection among surgery patients, which in turn delays normal recovery process and increases hospital length of stay and health care costs. Case study: A 34-years-old woman underwent ORIF surgical procedure on 22/3/2023 and developed symptoms like oozing of pus from surgical site on fifth day of post-surgery, fever spikes on same day, increase of pain at surgical site. She was treated with linezolid-600mg-BD a day intravenously and Meropenem-1gm-BD a day intravenously. After 10 days she made eventful recovery and got discharged. Microbiology Examination and Diagnosis: Pus sample collected from surgical site gave rise to growth of Pseudomonas aeruginosa on mac cockney agar medium. Pseudomonas aeruginosa of this particular sample showed resistance to most of the antibiotics that were tested. Discussion: Patient’s conditions like duration of operative procedure (>2 hours), immune-compromised condition like type II Diabetes, obesity, antibiotic prophylaxis and class of wound all these factors becomes risk factors for developing SSI. Conclusion: These infections are more common in elderly patients, patients undergoing emergency surgeries, longer surgical duration (>2 hours), and patients with a high ASA index. In order to decrease incidence of SSI we would have to: a) decrease the duration of the surgeries performed b) focus on regular and intensive drain care c) if a patient has any conditions that can complicate the surgical procedure rule out them first with proper management d) conduct periodic surveillance to keep a check on SSI.

Hepatic Abscess in Adults: Integrated Approach and Surgical Considerations

Hepatic abscesses are suppurated cavities caused by the invasion and multiplication of microorganisms within the liver parenchyma. This condition is relatively uncommon, with an estimated incidence of 2.3 to 3.6 cases per 100,000 people yearly. However, the incidence is higher in specific populations, such as patients with underlying liver disease, diabetes, or other immune-compromising conditions. The most common cause of liver abscesses is the spread of infection from other parts of the body, such as the biliary tract or gastrointestinal tract. Other causes include trauma to the liver, such as from a penetrating injury or surgery or the presence of a foreign body in the liver. Liver abscesses are broadly divided into two types: amoebic and pyogenic. The clinical presentation might vary, including fever, abdominal pain, nausea and vomiting, jaundice, and weight loss. In some cases, there may be no symptoms. Diagnosis typically involves an ultrasound or CT scan, which can show the presence of a fluid-filled mass in the liver. CT is the standard modality for diagnosis. Blood tests may also evaluate liver function and identify any underlying infections. Treatment typically involves a combination of antibiotics to target the underlying infection and drainage of the abscess. Supportive measures like hydration and pain management may also be necessary. In addition, close monitoring and follow-up are essential to ensure that the abscess has resolved and there are no complications. In some cases, surgical intervention may be necessary to remove the abscess or repair any damage to the liver. Liver abscess drainage is typically indicated in patients with significant, symptomatic abscesses or those who do not respond to medical treatment with antibiotics. In addition, abscesses at risk of rupturing or located close to vital structures, such as major blood vessels, may require drainage to prevent serious complications. Two drainage methods are presently available: non-surgical options, such as percutaneous needle aspiration or percutaneous catheter drainage, and surgical options, such as open drainage or laparoscopic drainage. This review identifies when these alternatives should be used, taking adverse effects, symptoms, and comorbidities into account.

Bloodstream Infections with Opportunistic Pathogens in COVID-19 Era: A Real Challenge Necessitates Stringent Infection Control.

Background : Bloodstream infections (BSI) due to opportunistic microbes in the coronavirus disease 2019 (COVID-19) pandemic lead to high morbidity and mortality among hospitalized patients. Thus, it is vital to find out the risk factors of BSI and to learn the ways to mitigate it. Aim : The aim of this study was to evaluate important risk factors of BSI due to opportunistic pathogens and to assess the role of the rigid infection control program to deal with this issue. Methods : A prospective, cross-sectional study was performed for 6 months on 150 patients admitted in both COVID-19 and non-COVID-19 intensive care units of our hospital. BSI was confirmed by the BACTEC and Vitek 2 compact system. Prospective surveillance and environmental sampling were carried out for source tracking along with rigorous infection control measures and the outcome was analyzed. Findings : Burkholderia cepacia, Elizabethkingia meningoseptica, Candida auris, vancomycin-resistant Enterococcus , and Achromobacter xylosoxidans were the common opportunistic pathogens isolated from a single or paired blood sample(s) in our study. Key risk factors were prolonged intensive care unit stay, central venous access, mechanical ventilation, immune-compromised condition, and use of biologics. Reverse osmosis water and used normal saline bottles were the common environmental source of infection. Following the implementation of precise infection control measures, there was a sharp decline in BSI cases, which was not attributed to the downfall of COVID-19 cases. Conclusion : Combined prospective surveillance and environmental sampling helped to find out the sources and implementation of an intensive and insistent infection control program that are needed to control opportunistic pathogens mediated BSI.

“PHENOTYPIC EVALUATION OF ANTIFUNGAL SUSCEPTIBILITY PATTERN OF Candida albicans ISOLATED FROM DIFFERENT CLINICAL SAMPLES BY KIRBY-BAUER DISC DIFFUSION AND BROTH MICRODILUTION METHOD TO FLUCONAZOLE AND AMPHOTERICIN B”

Introduction: Candidiasis is a major fungal infection where Candida albicans is the major cause of infections in humans. Candida albicans is an opportunistic pathogen under immune-compromised conditions and despite anti-fungal therapies, it has become lethal. Increase in the antimicrobial resistance in C. albicans is a matter of concern as it is in the human microbiome.
 Aim and Objective: To determine the antifungal susceptibility pattern of Candida albicans isolated from different clinical samples against Fluconazole and Amphotericin B by Kirby Bauer disc diffusion method and Broth microdilution method.
 Materials and Methods: This was a cross sectional study carried out in the Department of Microbiology at Rama Medical College Hospital and Research Centre Mandhana, Kanpur for a period of 1 year i.e, April 2018 to April 2019. A total of 70 isolates of Candida species from different clincal specimens like blood, BAL, urine, Pus, Et secreation and vaginal secreation were evaluated for its susceptibility against Fluconazole and Amphotericin B using Kirby Bauer disc diffusion method and Broth micro dilution method according to the CLSI guidelines 2018.
 Results: Out of 70 isolates of Candida species 29 (41.4%) isolates were confirmed to be C.albicans. The ratio of Males 18 (62%) was more as compared to that of the Females 11(37.9%) with the maximum age of 31-40 being affected the most followed by 41-50 and least in the age group above 61 years of age. The number of isolates was maximum in the urine sample. A total of 12 (41.3%) samples of Candida were sensitive and 17 (58.6%) samples were resistant to Amphotericin B & 27(93%) samples of Candida were sensitive and 2(6.8%) samples were resistant to Fluconazole by Kirby bauer disc diffusion method. 28(96.5%) samples of Candida were sensitive and 1(3.4%) sample was resistant to Amphotericin B & 25 (86.2%) samples of Candida were sensitive and 4(13.7%) samples were resistant to Fluconazole by broth microdilution method.
 Conclusion: The Antifungal susceptibility testing by broth microdilution method revealed that fluconazole was exceedingly resistant against Candida albicans (13.7%) and increasingly susceptible to Amphotericin B (96.5%). Antifungal susceptibility testing may possibly be used to calculate the clinical response, to forecast malfunction in management. Therefore, Proper administration of antifungal drugs should be prioritized only with susceptibility result testing.

Recent Developments in Mycobacteria-Based Live Attenuated Vaccine Candidates for Tuberculosis.

Vaccination is an excellent approach to stimulating the host immune response and reducing human morbidity and mortality against microbial infections, such as tuberculosis (TB). Bacillus Calmette-Guerin (BCG) is the most widely administered vaccine in the world and the only vaccine approved by the World Health Organization (WHO) to protect against TB. Although BCG confers "protective" immunity in children against the progression of Mycobacterium tuberculosis (Mtb) infection into active TB, this vaccine is ineffective in protecting adults with active TB manifestations, such as multiple-, extensive-, and total-drug-resistant (MDR/XDR/TDR) cases and the co-existence of TB with immune-compromising health conditions, such as HIV infection or diabetes. Moreover, BCG can cause disease in individuals with HIV infection or other immune compromises. Due to these limitations of BCG, novel strategies are urgently needed to improve global TB control measures. Since live vaccines elicit a broader immune response and do not require an adjuvant, developing recombinant BCG (rBCG) vaccine candidates have received significant attention as a potential replacement for the currently approved BCG vaccine for TB prevention. In this report, we aim to present the latest findings and outstanding questions that we consider worth investigating regarding novel mycobacteria-based live attenuated TB vaccine candidates. We also specifically discuss the important features of two key animal models, mice and rabbits, that are relevant to TB vaccine testing. Our review emphasizes that the development of vaccines that block the reactivation of latent Mtb infection (LTBI) into active TB would have a significant impact in reducing the spread and transmission of Mtb. The results and ideas discussed here are only based on reports from the last five years to keep the focus on recent developments.

The dual role of CD6 as a therapeutic target in cancer and autoimmune disease.

Autoimmune disease involves loss of tolerance to self-antigen, while progression of cancer reflects insufficient recognition and response of the immune system to malignant cells. Patients with immune compromised conditions tend to be more susceptible to cancer development. On the other hand, cancer treatments, especially checkpoint inhibitor therapies, can induce severe autoimmune syndromes. There is recent evidence that autoimmunity and cancer share molecular targets and pathways that may be dysregulated in both types of diseases. Therefore, there has been an increased focus on understanding these biological pathways that link cancer and its treatment with the appearance of autoimmunity. In this review, we hope to consolidate our understanding of current and emerging molecular targets used to treat both cancer and autoimmunity, with a special focus on Cluster of Differentiation (CD) 6.

P469 Feline aspergillosis caused by Aspergillus candidus: A case report

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMAspergillosis is an emerging mycosis that can occur in apparently healthy animals under environmental stress or immune-compromised condition. In cats, the clinical forms described are sinonasal, synoorbital, and, less frequently, invasive and disseminated forms.Feline aspergillosis is caused mainly by cryptic species of Aspergillus closely related to Aspergillus fumigatus. It is rare to recover species such as A. candidus, an endophytic fungus, opportunistic pathogen, and contaminant of cereals, nuts, and flour. It is described to cause allergic alveolitis or asthma, mycotoxicosis, and other related diseases. Mycelial fragments, inhaled spores, and substances such as terpenoids, flavones, and indoles in the lungs could be involved in the underlying pathogenesis.This presentation aims to describe a clinical case of feline pneumonia caused by A. candidus.Clinical caseWe present the clinical case of a common European breed feline of ∼ 7 years of age. The cat was rescued from the streets of an urban area in Buenos Aires and examined in April 2021. The feline suffered from mild hyperthermia, 39.4°C, had pale to slightly purple mucous membranes, cachexia, dehydration, dyspnea (abdominal respiration), tachycardia, and a large number of parasites. There were no nasal discharge, cough, or skin lesions. A hemogram with a blood biochemistry profile showed no significant alterations. Chest X-rays showed a pattern compatible with severe miliary pneumonia. A bronchoalveolar lavage (BAL) was performed for cytology and microbiological culture; direct examination showed nucleated superficial epithelial cells without atypia, few macrophages, no leukocytes, and gram-positive cocci, while ZN and mycological direct examination were negative. Treatment with doxycycline 10 mg/k every 12 h and dexamethasone was indicated. Flea treatment and control were conducted every 72 h. During the following consultations, the cat continued tachypnoeic and showed increased vesicular murmur with rales and cough. Corticosteroids (Fluticasone propionate 125 mg) were given every 12 h intranasal. Oral parasitization was performed due to the presence of Dipylidium caninum in feces. After 7 days of incubation, white cottony colonies phenotypically identified as Aspergillus grew on Sabouraud dextrose agar. Even though serum galactomannan GM (Platelia Aspergillus EIA BIORAD®) is useful as a biomarker in humans with OD >0.5 positive for invasive aspergillosis, it was used in this case and the result was OD 0.75. Antifungal treatment was started with itraconazole orally at 5 mg/kg/d. A mycobacterial culture was negative.The isolate was identified by partial sequencing of the calmodulin gene CaM as A. candidus.The feline showed a remarkable recovery. After 35 days from the start of the treatment, the final consultation showed a decrease in the pattern of military pneumonia through radiological images and an absence of any evident respiratory symptoms.ConclusionWe describe a fungal infection in a cat caused by an unusual species of Aspergillus. Moreover, this clinical case was proved to be pneumonia. Given this, it is important to consider this species as an emerging pathogen in cats.

Immune-related therapeutics: an update on antiviral drugs and vaccines to tackle the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic rapidly spread globally. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, is a positive-sense single-stranded RNA virus with a reported fatality rate ranging from 1% to 7%, and people with immune-compromised conditions, children, and older adults are particularly vulnerable. Respiratory failure and cytokine storm-induced multiple organ failure are the major causes of death. This article highlights the innate and adaptive immune mechanisms of host cells activated in response to SARS-CoV-2 infection and possible therapeutic approaches against COVID-19. Some potential drugs proven to be effective for other viral diseases are under clinical trials now for use against COVID-19. Examples include inhibitors of RNA-dependent RNA polymerase (remdesivir, favipiravir, ribavirin), viral protein synthesis (ivermectin, lopinavir/ritonavir), and fusion of the viral membrane with host cells (chloroquine, hydroxychloroquine, nitazoxanide, and umifenovir). This article also presents the intellectual groundwork for the ongoing development of vaccines in preclinical and clinical trials, explaining potential candidates (live attenuated-whole virus vaccines, inactivated vaccines, subunit vaccines, DNA-based vaccines, protein-based vaccines, nanoparticle-based vaccines, virus-like particles and mRNA-based vaccines). Designing and developing an effective vaccine (both prophylactic and therapeutic) would be a long-term solution and the most effective way to eliminate the COVID-19 pandemic.

Pathogenesis of Mucormycosis: The Spores on a Sail

Fungi of the order Mucorales are capable to infect human beings and animals. Mucormycosis is a well-known, life-threatening infection, primarily occurring in immune-compromised conditions like diabetic ketoacidosis, organ transplantation, increased serum iron and neutropenia. The mortality and morbidity rate due to Mucormycosis is rapidly rising despite of surgical debridement and antifungal aids. In this article, we will review (i) the existing knowledge about fungi (ii) interaction of Mucorales with host immune system (iii) assessment of virulence factors of Mucorales which play a key role in infection like high-affinity iron permease FTR1, spore coat protein CotH, reductase permease system. Since Mucormycosis infection is angioinvasive in nature, emphasis is placed on the ways by which organisms acquire iron from the host and its interaction with blood vessels. The present mini-review attempts to spread awareness regarding difficult to treat infection of mucormycosis and to provide possible targets for future research for therapeutic measures.

A Subcutaneous Abscess Caused by Candida Krusei Infection: A rare Manifestation

Candida is considered a normal microbiota of the gastrointestinal and genitourinary systems with a tendency for an invasive disease if the predisposing conditions exist. Mucocutaneous manifestations of Candida infection include the commonly encountered oropharyngeal thrush, vulvovaginitis, balanitis, intertrigo, paronychia, diaper dermatitis, and the rare chronic mucocutaneous candidiasis. Subcutaneous abscess due to Candida (albicans and non-albicans) is rare, with the literature available only in case reports. We report the first case of a subcutaneous perineal abscess due to C. krusie in a patient with poorly controlled diabetes without immune compromised conditions or a hematologic malignancy.

Infection of mucormycosis inpatients in Covid-19

Introduction: Mucormycosis is a rare infection known to be one of the most rapidly progressing and lethal forms of fungal infection in humans, with a high mortality rate of 70–100%. Covid-19 cases were reported from all states of the country, but cases of mucormycosis in the setting of COVID-19 pneumonia were very low and that too reasoned that this was most likely due to the patient’s immune-compromised condition. Aims and Objectives: The aim of this article is to assess mucormycosis in Covid-19 patients and its association with the immune status of patients. Materials and Methods: Over 5 months, from February 2021 to June 2021, a retrospective observational study was conducted at MGM Medical College, Aurangabad, Maharashtra, India. The study included all patients who came for imaging to the Radiology Department with mucormycosis who were either coronavirus-positive or had recovered from coronavirus infection. All patients with a molecular diagnosis of SARS-CoV-2 infection admitted to our hospital and having a clinical diagnosis of invasive fungal infections were included. Results: All 30 (100%) patients were diabetic; 17 of these had uncontrolled blood sugar levels with HbA1C levels >6.5%, and the remaining 13 patients had controlled diabetes. The majority of uncontrolled diabetics (17 out of 30) had invasive mucormycosis, rhino-orbital mucormycosis and rhino-orbital cerebral stage, whereas only 3 subjects with control diabetes had invasive mucormycosis. Five uncontrolled diabetic patients had rhino-orbital cerebral stage, whereas only two controlled had rhino-orbital cerebral stage. There is a significant difference between controlled and uncontrolled diabetes with P-value of 0. Conclusion: Covid-19 connection to invasive mucormycosis infection is extremely dangerous and should be taken seriously. Uncontrolled diabetes and inappropriate use of steroids during the management of Covid-19 are two of the most common causes of disease aggravation, and both must be addressed.

Review on mucormycosis in the oro-facial region: an overview

The study aims to identify the clinical manifestation of mucormycosis in the oro-facial region to distinguish the role of meticulous intraoral examination for early and timely diagnosis based on the review of reported cases, to propose the role of diabetes mellitus as a predisposing risk factor for mucormycosis in the oro-facial region, to propose the association of traumatic incidents like tooth extraction as a risk factor for mucormycosis in immune-compromised individuals and to perceive the use of amphotericin-B in its treatment. A systematic review was conducted on an electronic database, Google Scholar to analyze the existing data for the clinical manifestation of mucormycosis in the orofacial region. Out of the existing literature on this topic for various timelines, a period of 10 years from 2011 to 2021 was selected for the study. The sample size was calculated taking into consideration the 99.99% confidence interval. The data was extracted from these relevant articles in Microsoft Excel, showing remarkable conclusions. Mucormycosis does not show stereotypical clinical manifestations and thus the diagnosis of mucormycosis has to be confirmed through culture studies and histopathological or radiological ways. Diabetes Mellitus serves as a predisposing factor for mucormycosis in the oro-facial region other than the COVID-19 infection and immune-compromised conditions. Amphotericin-B was a drug of choice for the treatment of mucormycosis by many practitioners. The only hindrance to its usage being its nephrotoxicity.

Real-World Clinical and Economic Outcomes in Selected Immune-Related Adverse Events Among Patients with Cancer Receiving Immune Checkpoint Inhibitors.

BackgroundWith increased use of immune checkpoint inhibitors (ICIs) among patients with cancer, there is substantial interest in understanding clinical and economic outcomes and management of immune‐related adverse events (irAEs).Patients, Materials, and MethodsA retrospective study was conducted using Premier Healthcare Database, a U.S. national hospital discharge database, from March 1, 2015, through December 31, 2017. The database comprises more than 880 million inpatient and hospital‐based outpatient encounters, with more than 200 million unique patients reported by 966 hospitals. Patients with four solid tumors known to benefit from ICI therapy were included. The list of irAEs assessed was defined a priori per American Society of Clinical Oncology clinical guidelines for irAE management. Baseline irAE‐related inpatient and outpatient visits were defined as the first inpatient or hospital‐based outpatient visit with discharge diagnosis of any irAE of interest following confirmed ICI usage within 90 days prior to the baseline visit. Patients were followed for 90 days after baseline irAE‐related inpatient discharge date or outpatient visit date to assess irAE‐related inpatient admissions, all‐cause in‐hospital mortality, ICI reinitiation, and to determine costs and health care resource utilization.ResultsRecords from 673,957 patients with four tumor types were reviewed for ICI therapy. Of 13,030 patients receiving ICIs, approximately 40% experienced at least one irAE, with a total of 10,121 irAEs occurring within 90 days of the ICI visit. The most frequent (>1,000 events) irAEs were anemia, impaired ventricular function with heart failure and vasculitis, thrombocytopenia, thyroid conditions, and peripheral edema. As might be expected, compared with those with baseline irAE‐related outpatient visits, patients with baseline irAE‐related inpatient visits had a significantly higher percentage of irAE‐related inpatient admissions (23% vs. 14%) and all‐cause in‐hospital mortality (22% vs. 6%) and lower reinitiation of ICI therapy (31% vs. 71%). Baseline irAE‐related inpatient visits had significantly higher mean costs ($29,477 vs. $5,718) with longer hospital stays (12.6 vs. 7.8 days).ConclusionFindings from a U.S. national hospital discharge database suggest that irAEs in patients treated with ICIs are common, occur in multiples and with greater frequency in those with pre‐existing comorbidities. Those with inpatient admissions have poorer outcomes.Implications for PracticeThe present work addressed the knowledge gap in understanding real‐world outcomes of immune‐related adverse events (irAEs) associated with immune checkpoint inhibitors (ICIs). Patients who experienced irAEs had significantly higher baseline comorbidities and were more likely to have immune‐related or immune‐compromised comorbid conditions. Patients with baseline irAE‐related hospitalizations were more likely to be rehospitalized and to experience in‐hospital mortality and less likely to reinitiate ICI treatment. Real‐world patients are more diverse than clinical trials, and clinicians should consider both the efficacy and safety profile of ICI treatments, especially for patients with comorbidity conditions. Close monitoring is needed after patients have experienced an irAE.

Anticandidal Activities by Lactobacillus Species: An Update on Mechanisms of Action.

Lactobacilli are among the most studied bacteria in the microbiome of the orodigestive and genitourinary tracts. As probiotics, lactobacilli may provide various benefits to the host. These benefits include regulating the composition of the resident microbiota, preventing – or even potentially reverting- a dysbiotic state. Candida albicans is an opportunistic pathogen that can influence and be influenced by other members of the mucosal microbiota and, under immune-compromising conditions, can cause disease. Lactobacillus and Candida species can colonize the same mucosal sites; however, certain Lactobacillus species display antifungal activities that can contribute to low Candida burdens and prevent fungal infection. Lactobacilli can produce metabolites with direct anticandidal function or enhance the host defense mechanisms against fungi. Most of the Lactobacillus spp. anticandidal mechanisms of action remain underexplored. This work aims to comprehensively review and provide an update on the current knowledge regarding these anticandidal mechanisms.

Simple Interrupted and Continuous Interlocking Suturing Techniques Comparison in Maxillofacial Trauma – A Randomized Controlled Trial

Aim: To compare the efficacy of simple interrupted and continuous interlocking suturing techniques using 3-0 vicryl (polyglactin) sutures. Method: The study sample included 20 patients (16 males and four females) with maxillofacial trauma requiring ORIF (Open Reduction and Internal Fixation) of maxilla or mandible fractures. They were randomly allocated to two groups (Group A and Group B). Patients in the age group of 20-50 years, requiring ORIF under local anesthesia or general anesthesia through an intraoral approach and incision measuring 4-6 cm were included in the study. Exclusion criteria included patients requiring extra-oral incisions, comminuted fractures with acute illness, infection, pregnancy, immune compromised conditions and patients not willing to participate in the study. Surgical site was closed in single layer using 3-0 vicryl sutures. Intraoperatively, time taken for suturing, wound dehiscence and wound healing were monitored on third, seventh and 30th day post-operatively. Results: In terms of time taken for suturing, dehiscence of wound and wound healing, continuous interlocking sutures showed superior results than that of simple interrupted sutures. Conclusion: Even though simple interrupted suturing is an easy technique, continuous interlocking suturing technique showed superior results. However, surgeons operating maxillofacial trauma may have their own point of view and selection of technique depends on individual preferences.