Low Incidence Of Disease Research Articles

High rates of colonization and antimicrobial resistance of group B streptococcus highlight the need for vaccination even after implementation of guidelines for intrapartum antibiotic prophylaxis

IntroductionIt is estimated that about 11–35% of pregnant women are colonized with Group B streptococcus. Intrapartum antibiotic prophylaxis (IAP) is the primary intervention to decrease the risk of infecting babies born to GBS colonized mothers. MethodsA total of 5,996 pregnant women, who received the Taiwanese universal GBS screening program from 2012 to 2020, were included in this study that investigated GBS colonization, antimicrobial resistance rates and their neonatal incidence of invasive GBS infection. ResultsThe average GBS colonization rate was 18.5%. Older age groups had higher colonization rates than younger age groups. Compared to Taiwanese, immigrant women from Indonesia had a greater positive rate. GBS isolated from Vietnamese women had significant greater resistance to clindamycin relative to Taiwanese women. Rates of resistance to erythromycin increase from 35.5% to 45.5% over the 9 years of measurements. The incidence of invasive GBS disease was about 0.6/1,000 (4/6,204) live births during the study. ConclusionsAlthough relatively low incidence of invasive GBS diseases was observed after implementation of IAP, the colonization of GBS remains high and antimicrobial resistance of GBS is increasing. An effective GBS vaccine holds promise to be a solution for these issues.

PVNS Of The Knee: A Consecutive Series of 53 Patients Treated Either Arthroscopically or With Open Synovectomy

Pigmented villonodular synovitis (PVNS) is a subtype of tenosynovial giant cell tumor. Such tumors are rare and locally aggressive, though benign, with an average annual incidence between 1.8 and 9.2 cases per million in the U.S. [1] This low incidence of disease makes clinical trials difficult to conduct. Clinically, PVNS is separated into localized (LPVNS) and diffuse (DPVNS) disease. Surgical options include open, arthroscopic and combination arthroscopic/ open approaches for disease involving both anterior and posterior compartments of a joint. Despite surgical resection being the most common treatment modality for PVNS, recent medications have been developed targeting the colony stimulating factor 1 receptor (CSF1R) pathway.[2] In our case series, we selected 53 patients meeting inclusion criteria and treated between 2002-2019

Microclimate suitability for green and coloured sweet pepper hybrids in open and protected structures in sub-tropical humid climate of West Bengal

A study was undertaken for two consecutive seasons (autumn-winter) to evaluate the performance of three green, red and yellow-fruited sweet pepper hybrids in open field and under two protected structures (50% green shade net house and naturally-ventilated polyhouse) to understand the microclimate suitability for maximizing the productivity of these hybrids under sub-tropical humid climatic condition of eastern India. In this climatic condition, naturally-ventilated polyhouse was most suitable for enhancing fruit yieldof both green and coloured fruited hybrids. Open field condition was not suitable for both yellow and redfruited hybrids. Though green-fruited hybrids could be grown in open field condition, fruit yield was more than double under polyhouse. Shade net house could not be considered as a suitable protected structure for sweet pepper in this climatic condition because of reduced light intensity and high relative humidity inside it causing low fruit set and high incidence of bacterial wilt disease. Maximum/minimum temperature30oC to 33oC / 14oC to 17oC with comparatively reduced light intensity of 35,000 to 55,000 lux, prevention of adverse effect of low night temperature during winter and  60 per cent relative humidity condition during flowering, fruit set and fruit development period inside the naturally ventilated polyhouse were most suitable growing conditions for getting maximum productivity of both green and colour-fruited hybrids of sweet pepper.

Inhibitory Effect of Trichoderma asperellum Isolate against Ralstonia solanacearum Causing Brinjal Wilt

A native Trichoderma isolate was collected from the agricultural soil of Gazipur. This isolate was identified as a Trichoderma asperellum through morphology and analysis of internal transcribed spacer (ITS) region of ribosomal RNA gene sequence and reconstruction of the phylogenetic tree. The antagonistic effects of the newly identified T. asperellum isolate were assessed against brinjal bacterial wilt caused by Ralstonia solanacearum both in vitro and in planta. Both qualitative and quantitative bioassays were conducted in vitro. For qualitative tests, dual culture and antibacterial activity were carried out, and pathogen growth was observed visually. The antagonism of T. asperellum cell free culture filtrate on the growth of R. solanacearum was conducted in a quantitative test. Successful antagonism was recorded after both in vitro qualitative tests. In addition, the lowest colony forming unit was recorded in 100% of CFC (2.4±0.51 ×103 cfu/ml) in quantitative test. The T. asperellum inoculated plant showed low disease incidence (13.33%) when seedlings were challenged with R. solanacearum in planta experiment. Disease incidence was 100% for seedlings when treated with only R. solanacearum. The results showed that the isolated and identified T. asperellum isolate suppressed R. solanacearum growth in vitro and protected the seedling from wilting in planta. Therefore, this isolate could be considered as a potential isolate. Ann. Bangladesh Agric. (2020) 24(2) : 107-120

Underutilization of diagnostic assays for celiac disease in Korea.

BackgroundTest utilization for the diagnosis of celiac disease may affect the prevalence and incidence of the disease in Korea. We aimed to investigate the test utilization of serological biomarkers for celiac disease in Korea.MethodsWe retrospectively investigated the test utilization of tissue transglutaminase IgA, gliadin IgA and IgG, and endomysial IgA antibody (Ab) assays between January 2011 and June 2020.ResultsDuring a nine‐year‐and‐six‐month study period, overall 307,322,606 clinical tests were requested from different clinical settings, such as local clinics, hospitals, university hospitals, and tertiary medical centers. Among them, only 58 tissue transglutaminase IgA, 22 gliadin IgA, 12 gliadin IgG, and 16 endomysial IgA Ab tests were performed on 79 Korean patients. Among them, one patient had positive transglutaminase IgA Ab result (1.3%).ConclusionLow prevalence and incidence of celiac disease in Korea may be due to an underutilization of diagnostic assays.

NKG2D Engagement Alone Is Sufficient to Activate Cytokine-Induced Killer Cells While 2B4 Only Provides Limited Coactivation.

Cytokine-induced killer (CIK) cells are an ex vivo expanded heterogeneous cell population with an enriched NK-T phenotype (CD3+CD56+). Due to the convenient and relatively inexpensive expansion capability, together with low incidence of graft versus host disease (GVHD) in allogeneic cancer patients, CIK cells are a promising candidate for immunotherapy. It is well known that natural killer group 2D (NKG2D) plays an important role in CIK cell-mediated antitumor activity; however, it remains unclear whether its engagement alone is sufficient or if it requires additional co-stimulatory signals to activate the CIK cells. Likewise, the role of 2B4 has not yet been identified in CIK cells. Herein, we investigated the individual and cumulative contribution of NKG2D and 2B4 in the activation of CIK cells. Our analysis suggests that (a) NKG2D (not 2B4) is implicated in CIK cell (especially CD3+CD56+ subset)-mediated cytotoxicity, IFN-γ secretion, E/T conjugate formation, and degranulation; (b) NKG2D alone is adequate enough to induce degranulation, IFN-γ secretion, and LFA-1 activation in CIK cells, while 2B4 only provides limited synergy with NKG2D (e.g., in LFA-1 activation); and (c) NKG2D was unable to costimulate CD3. Collectively, we conclude that NKG2D engagement alone suffices to activate CIK cells, thereby strengthening the idea that targeting the NKG2D axis is a promising approach to improve CIK cell therapy for cancer patients. Furthermore, CIK cells exhibit similarities to classical invariant natural killer (iNKT) cells with deficiencies in 2B4 stimulation and in the costimulation of CD3 with NKG2D. In addition, based on the current data, the divergence in receptor function between CIK cells and NK (or T) cells can be assumed, pointing to the possibility that molecular modifications (e.g., using chimeric antigen receptor technology) on CIK cells may need to be customized and optimized to maximize their functional potential.

Dengue and Zika virus infections in children elicit cross-reactive protective and enhancing antibodies that persist long term.

Dengue virus serotypes 1 to 4 (DENV1–4) and Zika virus (ZIKV) are mosquito-borne flaviviruses that induce both virus-specific and broadly reactive antibodies. A first DENV infection is thought to induce antibodies that wane over 2 years to titers that can subsequently enhance severe dengue disease. Secondary DENV infection with a different serotype is thought to induce stable, cross-serotype protective antibodies. Low dengue disease incidence after the recent Zika pandemic led to the hypothesis that ZIKV infection is also transiently cross protective. We investigated antibody kinetics in 4189 children up to 11 years after one and multiple DENV and ZIKV infections in longitudinal cohorts in Nicaragua. We used a DENV inhibition enzyme-linked immunosorbent assay (iELISA), which measures antibodies associated with protection against dengue and Zika disease and with enhancement of dengue disease severity. Unexpectedly, we found that overall DENV iELISA titers stabilized by 8 months after primary DENV infection to a half-life longer than a human life and waned, although gradually, after secondary DENV infection. Similarly, DENV iELISA titers were stable or rose after primary ZIKV infection but declined in individuals with histories of DENV and ZIKV infection. In contrast, kinetics of anti-ZIKV antibodies after ZIKV infection were similar regardless of prior DENV immunity. We observed heterogeneity in DENV iELISA titer, suggesting that individual antibody titer set point, rather than waning, is important for future dengue disease risk. Together, these findings change our understanding of anti-flavivirus antibody kinetics and have implications for measuring vaccine efficacy and for predicting future dengue and Zika outbreaks.

Bio-control of Stem Rot in Jerusalem Artichoke (Helianthus tuberosus L.) in Field Conditions.

Stem rot is a serious disease in Jerusalem artichoke (JA). To reduce the impact of this disease on yield and quality farmers often use fungicides, but this control method can be expensive and leave chemical residues. The objective of this study was to evaluate the efficacy of two biological control agents, Trichoderma harzianum T9 and Bacillus firmus BSR032 for control of Sclerotium rolfsii under field conditions. Four accessions of JA (HEL246, HEL65, JA47, and JA12) were treated or notreated with T. harzianum T9 and B. firmus BSR032 in a 4 × 2 × 2 factorial experiment in two fields (environments), one unfertilized and one fertilized. Plants were inoculated with S. rolfsii and disease was evaluated at 3-day intervals for 46 days. T. harzianum T9 and B. firmus BSR032 reduced disease incidence by 48% and 49%, respectively, whereas T. harzianum T9 + B. firmus BSR032 reduced disease incidence by 37%. The efficacy of T. harzianum T9 and B. firmus BSR032 for control of S. rolfsii was dependent on environments and genotypes. The expression of host plant resistance also depended on the environment. However, HEL246 showed consistently low disease incidence and severity index in both environments (fertilized and unfertilized). Individually, T. harzianum T9, B. firmus BSR032, or host plant resistance control stem rot caused by S. rolfsii in JA. However, no combination of these treatments provided more effective control than each alone.

Engineering Multigenerational Host-Modulated Microbiota against Soilborne Pathogens in Response to Global Climate Change.

Simple SummaryIn order to face the challenges posed by climate change, scientific research should be directed towards global needs while also keeping into account the need for increased plant productivity. In this sense, our scientific group from the Biocontrol Research Laboratory BIOREN (Temuco, Chile) and our collaborators, have been studying the enormous potential to enhance productivity by using suppressive soils. In this review, we highlight soil-suppressive microbiota as a natural source of biocontrol agents and we propose a strategy to create microbial assemblages, where the plant selects its own inoculants (when plants “cry for help”). This approach is based on the selection of specific taxa during the transition from a conducive to a suppressive soil. We hope that this strategy leads to generation of personalized bioinoculants to counteract the effects of climate change and increase agricultural sustainability.Crop migration caused by climatic events has favored the emergence of new soilborne diseases, resulting in the colonization of new niches (emerging infectious diseases, EIDs). Soilborne pathogens are extremely persistent in the environment. This is in large part due to their ability to reside in the soil for a long time, even without a host plant, using survival several strategies. In this regard, disease-suppressive soils, characterized by a low disease incidence due to the presence of antagonist microorganisms, can be an excellent opportunity for the study mechanisms of soil-induced immunity, which can be applied in the development of a new generation of bioinoculants. Therefore, here we review the main effects of climate change on crops and pathogens, as well as the potential use of soil-suppressive microbiota as a natural source of biocontrol agents. Based on results of previous studies, we also propose a strategy for the optimization of microbiota assemblages, selected using a host-mediated approach. This process involves an increase in and prevalence of specific taxa during the transition from a conducive to a suppressive soil. This strategy could be used as a model to engineer microbiota assemblages for pathogen suppression, as well as for the reduction of abiotic stresses created due to global climate change.

Living with sickle cell disease: voices from sub-Saharan Africa

Sickle cell disease is sometimes wrongly considered as an African crisis or, at best, a disease affecting minority ethnic groups. However, it is a global crisis affecting millions of people throughout the world, irrespective of race or continent of origin, although it is common in people of African descent (including African Americans), people from Asia, including India, and Hispanic Americans. Globally, about 305 000 children are born with sickle cell disease every year, a quarter of sickle cell disease births worldwide are reported in Nigeria, and Tanzania records about 10 000 sickle cell disease births annually. In Ghana, about 15 000 newborns are diagnosed with sickle cell disease every year. South Africa has a low incidence of sickle cell disease compared with Nigeria, Ghana, and Tanzania, but this might be gradually changing due to immigration patterns from countries where sickle cell disease is more prevalent. SickleInAfricaOver the past 20 years, organised efforts in Africa have described and addressed the burden of sickle cell disease, with commendable achievements. However, there have been four limiting factors. First, there have been few multi-site, well described cohort studies of sickle cell disease in Africa. Second, there is no evidence yet that consistent standards of care are applied across Africa. Third, there are insufficient human resources, both in numbers and skills. Finally, there are few programmes exploring pertinent research questions related to sickle cell disease in Africa to guide locally appropriate interventions. Full-Text PDF

MenQuadfi (MenACWY-TT): A New Vaccine for Meningococcal Serogroups ACWY.

This article reviews data encompassing the pharmacology, efficacy, and safety of MenACWY-TT (MenQuadfi), a conjugate vaccine to prevent meningococcal disease from serogroups A, C, W, Y. A literature review was conducted in PubMed, MEDLINE, and ClinicalTrials.gov from inception up to July 2021, using the search terms MenQuadfi, meningococcal ACWY vaccine, MCV4, and menacwy. Articles from reference lists were included to identify potential relevant literature. Data were limited to randomized phase II and III clinical studies published in the English language, evaluating the efficacy and safety of MenACWY-TT. Animal studies and studies not utilizing MenACWY-TT were excluded. One phase II and 4 phase III randomized clinical studies, enrolling approximately 7700 participants, aged 2 years to 97 years old found that MenACWY-TT was noninferior when compared to established MenACWY vaccines, as measured by surrogate immunogenicity end points. In studies evaluating primary dose vaccination, conducted in those aged 2 to 97 years of age, the difference in seroresponse rates, reported by the lower bound of the 95% CI, was (A) 1.1% to 14.8%, (C) 21% to 42.2%, (Y) 7.7% to 24.6%, and (W) 8.9% to 22.5%. Despite the low incidence of meningococcal disease in the United States, meningococcal disease causes significant morbidity and mortality if not prevented. MenACWY-TT is noninferior to currently approved quadrivalent meningococcal vaccines and shows similar immunogenicity and safety as both an initial vaccine for prevention as well as a booster dose.

Establishment of a Fast-Track Gastrectomy Pathway for Patients With Gastric Adenocarcinoma at a U.S. Academic Cancer Center

IntroductionImplementation of fast-track perioperative care pathways for gastric cancer patients in the U.S. has been challenging due to low disease incidence and limited safety and efficacy data. Our institution recently implemented such a pathway for gastric cancer patients undergoing gastrectomy, and we sought to study its effects. MethodsWe analyzed data from consecutive patients who underwent gastrectomy for gastric adenocarcinoma from January 2014 to August 2020. Patients who had surgery for recurrence, urgent surgery for obstruction, bleeding, or perforation, or an intrathoracic anastomosis were excluded. The primary predictor was whether the patient had surgery before or after implementation of a perioperative fast-track gastrectomy pathway in July 2018, and the primary outcome was length of stay. ResultsOne hundred sixty patients were identified, 109 pre-pathway implementation and 51 post-pathway implementation. Following pathway implementation, length of stay was significantly shorter (median 6 days versus 9 days, p < 0.001), and there was no significant difference in 30-day complication rates (29% pre versus 24% post, P = 0.56) or readmission rates (18% pre versus 16% post, P = 0.85). Using linear segmented regression analysis adjusting for age, body mass index, tumor stage (early versus late), type of surgery (distal/subtotal versus total gastrectomy), and approach (open versus minimally invasive), pathway implementation was found to be associated with a 31% decreased length of stay (effect size 0.69, 95% confidence interval 0.49 – 0.98, P = 0.04). ConclusionsFast-track gastrectomy care pathways are safe and feasible for U.S. gastric cancer patients undergoing gastrectomy and are associated with decreased length of stay.

Decision-making on prophylactic measures in animal breeding farms

The performance of a production system constantly requires good sanitary practices, minimizing the risks of disease development in the herds, through preventive or curative prophylactic measures, as well as the adoption of hygiene measures. In this sense, an analytical-descriptive study was carried out on the actions taken by rural producers after participating in an international exhibition of animals, in the State of Rio Grande do Sul, in order to identify the prophylactic measures adopted when returning to the properties source. Semi-structured questionnaires were applied, in the form of interviews, to 13 rural producers, who work with different species and races, intentionally sampled and having as selection criteria the interest in participating in the research. The producers were asked about the management established in relation to the hygiene and prophylaxis measures with the animals participating in exhibitions and fairs, as well as on the incidence of diseases in the herd when returning to the production unit. Of the thirteen interviewees, three (23%) reported adopting differential management measures on the return of animals to property; the occurrence of diseases in the animals after the return to the UP, was reported in three UPs. The result found was significantly different from the expected one (P &lt; 0.001), if not adopting adequate health management could culminate with an increase in the incidence of diseases Cheers. Although the low incidence of diseases in the herds is reported by the interviewees, hygiene and prophylaxis measures are essential tools for the prevention and control of communicable diseases.

Prophylactic pretransplant ganciclovir to reduce cytomegalovirus infection after hematopoietic stem cell transplantation

Objective/BackgroundCytomegalovirus (CMV) reactivation remains a serious complication after allogeneic hematopoietic cell transplantation (HCT) occurring in approximately 60–70% of CMV-seropositive HCT recipients. CMV reactivation leads to adverse outcomes including end-organ damage, graft-versus-host disease, and graft failure. MethodsGanciclovir was administered pretransplant at 5 mg/kg twice daily intravenously from the start of conditioning to Day T-2 to CMV-seropositive patients receiving their first allogeneic HCT. CMV DNA was monitored weekly until at least Day 100 posttransplant. ResultsA total of 109 consecutive patients were treated, median age 57 (range 20–73) years. Of these, 36 (33%) patients had a CMV reactivation within the first 105 days posttransplant with a median time of reactivation of 52.5 (range 36–104) days posttransplant. The cumulative incidence of CMV reactivation at Day 105 posttransplant was 33.1% (95% confidence interval: 24.4–42.0). One patient developed CMV disease. ConclusionThe use of pretransplant ganciclovir was associated with low incidence of CMV reactivation and disease. These data suggest that pretransplant ganciclovir with preemptive therapy for viral reactivation may be a useful strategy to reduce CMV reactivation. Future prospective trials are needed to compare strategies for CMV prophylaxis.

MO269INCREASED RISK OF DEATH IN PATIENTS WITH DOUBLE POSITIVE SEROLOGY OF ANTI-GLOMERULAR BASE MEMBRANE (ANTI-GBM) ANTIBODIES AND ANTI-NEUTROPHIL CYTOPLASMIC ANTIBODIES (ANCA)

Abstract Background and Aims Double positivity of anti-GBM and ANCA serology is uncommon but may represent a distinct disease entity of small vessel vasculitis. Previous research has been challenged by low disease incidence, and conflicting results pertaining to risk of death and ESRD. Accordingly, we examined incidence and outcomes based on data from multiple Danish nationwide healthcare registries. Method All patients with incident positive anti-GBM serology between 2013 and 2018 were identified from 3 of 4 administrative regions in Denmark. Serological positivity was defined as serum concentrations exceeding the upper reference level. Double positivity was defined by either presence of PR3-ANCA or MPO-ANCA within a margin of 30 days from inclusion. Baseline information and clinical diagnoses defined by administrative diagnoses were subsequently ascertained by cross-referencing of data from the Danish nationwide administrative registries. Risks of death or ESRD were compared based on adjusted absolute risk ratios (ARR) and cumulative incidences assessed based on the Aalen-Johansen estimator. Results A total of 118 patients with positive anti-GBM serology (4.4 cases/million/year) were identified. Concomitant ANCA serology was tested in 104 (88.1%), with 39 patients (37.5%) demonstrating double positivity (20 and 13 patients positive for PR3-ANCA (51.3%) and MPO-ANCA (33.3%), respectively, and 6 patients positive for all autoantibodies (5.8%)). Mean follow-up for the total study population was 1.9 (SD ±1.6) years. Compared with patients positive for anti-GBM alone, double positivity was associated with female gender (61.5%, P=0.02), and more frequent employment of plasma exchange (53.8%, P=0.04). No difference was observed with regard to age (63.2 years [SD 18.5], P=0.60), and mean anti-GBM concentration (125.5 [SD 182.4] IU/L vs. 108.9 [SD 212.7] IU/L, P=0.30). One-year mortality was 17.7% (n=14) in patients positive for anti-GBM alone, and 28.2% (n=11) in patients positive for both anti-GBM and ANCA. Double positive serology was associated with increased risk of death (ARR 2.10 [CI 1.20-3.65], P=0.009) (figure); however, there was no difference in risk of ESRD (ARR 1.28 [0.66-2.50], P=0.46). Of all identified patients, only 32 (27%) were diagnosed with anti-GBM disease according to ICD10 code (1.2 cases/million/year). In patients with confirmatory serology and ICD-10 code, 13 (40%) had double positive serology (46.2% PR3-ANCA and 53.8% MPO-ANCA). In the subset of patients with confirmatory ICD-10 code, double positivity was associated with male gender (63.2%, P=0.07), numerical lower mean age (56.1 [SD 25.2], P=0.50), and increased mean anti-GBM concentration (333.3 [SD 278.7] vs 150.7 [SD 146.5] P= 0.026). There was no difference in risk of death or ESRD between the two groups. Conclusion Double positivity of anti-GBM and ANCA serology plausibly defines a distinct group of patients and is associated with a higher risk of death. While the association between an ICD10-confirmed diagnosis of anti-GBM disease and anti-GBM serology is well established, the significance of serology alone remains uncertain.

Low incidence of hepatic veno-occlusive disease (VOD) in patients with B-cell acute lymphoblastic leukemia (B-ALL) treated with inotuzumab ozogamicin (INO) followed by allogeneic stem cell transplantation (allo-SCT).

e19024 Background: Hepatic VOD is an uncommon, but often fatal complication of allo-SCT. The risk is increased after INO, an anti-CD22 antibody conjugated to calicheamicin with high remission rates in relapsed CD22-positive B-ALL. Previous reports have described VOD rates as high as 19% in INO-treated patients who then received allo-SCT. We report our safety experience using INO followed by allo-SCT. Methods: We identified patients &gt;18 yrs with B-ALL treated with allo-SCT and INO in the University of Chicago IRB-approved SCT database. We reviewed the EMR for patient details, toxicities (CTCAE v5.0), and outcomes. Hepatic VOD was defined according to EBMT criteria. Overall survival (OS) was from time of allo-SCT to death or last follow-up. Results: Between 2010-2021, 72 adult patients with B-ALL received allo-SCT, and 17 also received INO as salvage therapy (Table). Median follow-up was 19 months (1-110). All received ursodiol prophylaxis and 15/17 received an azole for antifungal prophylaxis. They had median 2 cycles (1-3) of INO with median of 1.9 months (1-14) from the last dose of INO to allo-SCT. For cycle 1, 13/17 (77%) received 0.8 mg/m2 on D1 and 0.5 mg/m2 on D8 and D15. Of these, 11 had a subsequent cycle (5 with same dosing and 7 had 0.5 mg/m2 on D1, D8, and D15). 1 patient had 0.5 mg/m2 on D1, D8, and D15 for 2 cycles. 3 patients received 0.8 mg/m2 on D1 and 0.4 mg/m2 on D8 and D15 for 2 cycles. After INO, 10 patients achieved CR and 3 had CRi for ORR of 13/17 (76%). The 4 patients with persistent disease despite INO went into remission with a different salvage therapy prior to allo-SCT. Conditioning regimens are listed in Table 1. No patients developed VOD after allo-SCT. Within 2 yrs of allo-SCT, 3/17 (18%) relapsed and 7/17 (41%) died. The median OS was 21.2 months [18 - NR]. Conclusions: Limiting the number of INO cycles (median 2) prior to allo-SCT, delaying allo-SCT for 2 months after INO exposure, and avoiding dual alkylating agent conditioning may have contributed to the absence of VOD in our patients. Larger data sets will be useful to validate these important safety observations.[Table: see text]

Brain Metastases from Esophageal Squamous Cell Carcinoma: Clinical Characteristics and Prognosis.

PurposeDue to the low incidence of intracranial disease among patients with esophageal cancer (EC), optimal management for these patients has not been established. The aim of this real-world study is to describe the clinical characteristics, treatment approaches, and outcomes for esophageal squamous cell carcinoma (ESCC) patients with brain metastases in order to provide a reference for treatment and associated outcomes of these patients.MethodsPatients with ESCC treated at the Fourth Hospital of Hebei Medical University between January 1, 2009 and May 31,2020 were identified in an institutional tumor registry. Patients with brain metastases were included for further analysis and categorized by treatment received. Survival was evaluated by the Kaplan-Meier method and Cox proportional hazards models.ResultsAmong 19,225 patients with ESCC, 66 (0.34%) were diagnosed with brain metastases. Five patients were treated with surgery, 40 patients were treated with radiotherapy, 10 with systemic therapy alone, and 15 with supportive care alone. The median follow-up time was 7.3 months (95% CI 7.4-11.4). At last follow-up, 59 patients are deceased and 7 patients are alive. Median overall survival (OS) from time of brain metastases diagnosis was 7.6 months (95% CI 5.3-9.9) for all cases. For patients who received locoregional treatment, median OS was 10.9 months (95% CI 7.4-14.3), and survival rates at 6 and 12 months were 75.6% and 37.2%, respectively. For patients without locoregional treatment, median OS was 3.0 months (95% CI 2.5-3.5), and survival rates at 6 and 12 months were 32% and 24%, respectively. OS was significantly improved for patients who received locoregional treatment compared to those treated with systematic treatment alone or supportive care (HR: 2.761, 95% CI 1.509-5.053, P=0.001). The median OS of patients with graded prognostic assessment (GPA) score 0-2 was 6.4 months, compared to median OS of 12.3 months for patients with GPA >2 (HR: 0.507, 95% CI 0.283-0.911).ConclusionBrain metastases are rare in patients with ESCC. GPA score maybe a useful prognostic tool for ESCC patients with brain metastases. Receipt of locoregional treatment including brain surgery and radiotherapy was associated with improved survival.

Estimating asymptomatic SARS-CoV-2 infections in a geographic area of low disease incidence

BackgroundThe SARS-CoV-2 infection has emerged as a rapidly spreading infection. Today it is relatively easy to isolate Covid-19 symptomatic cases, while remains problematic to control the disease spread by infected but symptom-free individuals. The control of this possible path of contagion requires drastic measures of social distancing, which imply the suspension of most activities and generate economic and social issues. This study is aimed at estimating the percentage of asymptomatic SARS-CoV-2 infection in a geographic area with relatively low incidence of Covid-19.MethodsBlood serum samples from 388 healthy volunteers were analyzed for the presence of anti-SARS-CoV-2 IgG by using an ELISA assay based on recombinant viral nucleocapsid protein.ResultsWe found that 7 out of 388 healthy volunteers, who declared no symptoms of Covid-19, like fever, cough, fatigue etc., in the preceding 5 months, have bona fide serum anti-SARS-CoV-2 IgG, that is 1.8% of the asymptomatic population (95% confidence interval: 0.69–2.91%).ConclusionsThe estimated range of asymptomatic individuals with anti-SARS-CoV-2 IgG should be between 26,565 and 112, 350. In the same geographic area, there are 4665 symptomatic diagnosed cases.

Risk Factors for Ovarian Cancer among Libyan Women

Ovarian cancer is the third type of gynecologic cancer in terms of prevalence after cervical and uterinecancer. The disease is known as the silent killer as it is slowly spread without a diagnosis, which leads to theworst prognosis and high mortality rate. Libya shows low disease incidence while the high mortality rate isseen in developed countries due to a lack of proper diagnostic and treatment options. This research aims tounderstand the various risk factors of ovarian cancer among the women in Libya. A questionnaire is usedin a quantitative research methodology using stratified random sample over the population is divided in twoclasses namely healthy and diseased, based on earlier diagnosis and ovarian cancer care. The diseased andhealthy women were targeted in a written survey in different hospitals and clinics in Libya. The data analysisis done in four stages. The first stage is cleaning and coding of the data. The second step is the demographicprofile of the respondents. The third stage. Frequency distribution of the data in order to compare the healthyand diseased women. The fourth stage is the linear logistic regression in order to determine the risk factorsfor ovarian cancer and test the research hypotheses. The logistic regression analysis indicated good fit of themodel. The model was able to correctly predicted 81.4 % of the cases which is 19.6 % increase over the nullmodel. The logistic regression analysis was also used to indicate the predictors namely family history, levelof obesity, ovulation information, use of birth control and breast feeding unlike awareness, nature of dietwhich was not predictor in the model.

Risk Factors for Ovarian Cancer: A Literature Review

Ovarian cancer is the third type of gynecologic cancer in terms of prevalence after cervical and uterinecancer. The disease is known as the silent killer as it is slowly spread without a diagnosis, which leads tothe worst prognosis and high mortality rate. Libya shows low disease incidence while the high mortalityrate is seen in developed countries due to a lack of proper diagnostic and treatment options. This researchaims to understand the various risk factors of ovarian cancer described in literature. Based on the literaturereview related to various factors which are the demographic, reproductive history, hormonal factors, geneticfactors, lifestyle such as diet and BMI. Various controversial in literature exist on the effect of these factorsand their association with risk factors.