Better than Nothing?: Consequence of Incomplete Treatment of COVID-19

With seemingly no end to the global pandemic in sight, high expectations are growing for the development of medicines to treat COVID-19, in addition to the vaccination which has been carried out recently. In Japan also, development of such medicines is accelerating and now four COVID-19 medicines have been approved.There is, however, concern that the COVID-19 medicines are not always effective, so that, in the present paper, we investigate the consequence of incomplete treatment of COVID-19-infected patients by constructing a simple intertemporal theoretical model. Main result we obtained is that incomplete treatment of infected patients increases number of the infected people, which is equivalent to say “worse than nothing”.

KOMBAT: Knowledgebase of Microbes’ Battling Agents for Therapeutics

Antimicrobial resistance (AMR) is one of the top 10 threats affecting global health. AMR defeats the effective prevention and treatment of infections caused by microbial pathogens including bacteria, parasites, viruses and fungi (WHO). Microbial pathogens have natural tendency to evolve and mutate over time resulting in AMR strains. The set of genes involved in antibiotic resistance also termed as “antibiotic resistance genes” (ARGs) spread through species by lateral gene transfer thereby causing global dissemination. While this biological mechanism is prevalent in the spread of AMR, human methods also augment through various mechanisms such as over prescription, incomplete treatment, environmental waste etc. A considerable portion of scientific community is engrossed in AMR related work trying to discover novel therapeutic solutions for tackling resistant pathogens. Comprehensive inspection of the literature shows that diverse therapeutic strategies have evolved over recent years. Collectively, these therapeutic strategies include novel small molecules, newly identified antimicrobial peptides, bacteriophages, phytochemicals, nanocomposites, novel phototherapy against bacteria, fungi and virus. In this work we have developed a comprehensive knowledgebase by collecting alternative antimicrobial therapeutic strategies from literature data. We have used subjective approach for datamining new strategies resulting in broad coverage of entities and subsequently add objective data like entity name, potency, safety information etc. The extracted data was organized KOMBAT (Knowledgebase Of Microbes’ Battling Agents for Therapeutics). A lot of these data are tested against AMR pathogens. We envision that this database will be noteworthy for developing future therapeutics against resistant pathogens. The database can be accessed through http://kombat.igib.res.in/.

Oral secretory leukocyte protease inhibitor (SLPI): Associations with oropharyngeal cancer and treatment outcome

Background Rates of oropharyngeal cancer (OPC) associated with alcohol & tobacco use have decreased, while human papillomavirus (HPV) associated OPC has increased among men in the US. Secretory leukocyte protease inhibitor (SLPI), detectable in a variety of secretions, has been implicated in cancers of the head and neck, associated with tumor progression and anti-viral activity. Using the recently verified oral gargle specimen, this study aimed to assess the association of salivary SLPI expression with risk of OPC and response to treatment. Methods A case-control study design compared levels of salivary SLPI among OPC cases to age and tobacco smoking matched healthy controls. Oral HPV DNA and SLPI was quantified from oral gargle specimens. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for associations of oral SLPI and risk of OPC and treatment outcomes. Results In crude and adjusted analyses of 96 OPC cases and 97 age- and smoking-matched controls, OPC was not significantly associated with oral gargle SLPI levels. Among cases, oral SLPI was associated with tonsillectomy (p = 0.018) and among controls oral SLPI was associated with HPV in the oral gargle (p = 0.008). Higher concentrations of SLPI was significantly associated with increased odds of incomplete treatment response (T2: OR: 12.39; 95% CI: 1.44–106.72; T3: OR: 9.86; 95% CI: 1.13–85.90) among all cases, but not among P16+ cases. Conclusions Salivary SLPI was not associated with OPC risk but was associated with higher odds of an incomplete treatment response.

The Impact of SARS-CoV-2 Outbreak on the Polish Dental Community’s Standards of Care—A Six-Month Retrospective Survey-Based Study

Currently, SARS-CoV-2 is the primary pathogen worldwide, disrupting most of our everyday activities. The study aim was to evaluate its impact on the Polish dental community, standards of care, health, and welfare. Methods: A Google Forms survey was conducted among 303 dental practitioners. Results: Of respondents, 54.93% curbed the number of patients in the last six months, 34.21% declared no changes, and 10.86% reported an increase; whereas 70.7% of the respondents reported a treatment price increase within the same period (27.96% and 1.32% reported no changes and a decrease, respectively). Of the respondents, 15.5% did not close their businesses during the first wave of the pandemic. Most declared 1 or 2 month break, 30.7% and 34.7%, respectively. Some reported 3, 4, or 5 month breaks (15.84%, 1.32%, and 0.99%, respectively), and only two respondents (0.66%) did not admit patients at all. Headache episodes were more frequent among female dentists before the pandemic; after the pandemic, headache frequency increased among both sexes. Temporomandibular disorders (TMDs) were more frequent among women (p = 0.017). Conclusions: Most Polish dentists followed SARS-CoV-2 recommendations and restricted their practices to admitting only patients with pain or incomplete treatment. Decreased sleep parameters, head, back, and neck pain, were observed. This situation may affect dental health conditions in Polish society over time.

A rare case of primary vaginal carcinoma in prolapsed uterus

Primary carcinoma is rare in gynaecological neoplasia. Vaginal carcinoma in prolapse uterus is extremely rare. We hereby present a case of 55-year-old P3L3 postmenopausal woman with complete uterine prolapse with fungating growth of 6x8 cm with two decubitus ulcers of 1x1 cm. Marginal biopsy showed well-differentiated squamous cell carcinoma of vagina. Investigation was done showed no metastasis. Patient was diagnosed with stage 2 disease. Patient underwent 5 cycles of chemotherapy with 2 cycles of radiotherapy and is being followed up. The importance of biopsy of ulcer in cases of UV prolapse in order to exclude malignancy to avoid incomplete treatment has been illustrated through this case. The need of careful evaluation of vaginal erosions in pelvic organ prolapse has been highlighted. As there is lack of well-defined treatment protocols for vaginal cancer with concurrent prolapse, the case also underlines the importance of a multidisciplinary approach involving gynaecological oncology, urogynaecology, medical oncology, surgical oncology and radiation oncology.

Backward bifurcation in a fractional-order and two-patch model of tuberculosis epidemic with incomplete treatment

In this paper, we consider a tuberculosis model with incomplete treatment and extend the model to a Caputo fractional-order and two-patch version with exogenous re-infection among the treated individuals, in which only susceptible individuals can travel freely between the patches. The model has multiple equilibria. We determine conditions that lead to the appearance of a backward bifurcation. The results show that the TB model can have exogenous reinfection among the treated individuals and, at the same time, does not exhibit backward bifurcation. Also, conditions that lead to the global asymptotic stability of the disease-free equilibrium are obtained. In case without reinfection, the model has four equilibria. In this case, the global asymptotic stability of the equilibria is established using the Lyapunov function theory together with the LaSalle invariance principle for fractional differential equations (FDEs). Numerical simulations confirm the validity of the theoretical results.

Mini invasive approaches in the treatment of small renal masses: TC-guided renal cryoablation in elderly

Background: Today, the goal of surgery is to achieve oncological efficacy with the lowest complication rate. Computed Tomography (CT)-guided cryoablation is proposed as a safe and effective technique. We report, our series of small renal masses treated with cryoablation in elderly (> 70 years). Methods: From May 2014 to April 2019, 32 patients with median (IQR) age of 75.5 years (range 71-80) with small renal masses (< T1a) diagnosis, clinical anesthesia contraindications to nephron-sparing surgery or patient’s will previous informed consent have been selected at our Urology Department. All patients underwent CT-guided cryoablation, preceded by needle biopsy. The cryoablation consisted in a procedure with an argon/helium gas-based system under local anesthesia. The follow-up included CT abdomen at 3, 6 and 12 months. The definition of incomplete treatment was the persistence of the lesion contrast enhancement (CE) at the end of the scan; the definition of relapse was the appearance of the CE to the 6-month control CT.Results: The median follow-up was 30 months (IQR 1-59). The median size of the tumor was 3.85 cm (IQR 1.6-4.5). All patients underwent lesion biopsy resulting in diagnosis of Renal Cell Carcinoma (RCC) in 29 patients (90.7%) and oncocytoma in 3 patients (9.3%). A median of 2 cryoprobes (IQR 1- 3) was used and 2/3 cycles of freeze-thaw of the duration of 10 minutes or 5 minutes were performed. Complications were: 3 asymptomatic transitional perirenal effusion, 2 lumbar pain well-controlled by analgesic drug. Hospital stay was 2 days (range 1-3). No case showed incomplete treatment and local relapse or metastates at the CT abdomen-pelvis with contrast medium at 12 months. Conclusions: This study shows the efficacy and safety of percutaneous cryoablation of small renal masses in elderly population. The procedure is easy to perform, with low complication rates and well tolerated by the elderly patients.

Intralesional measles, mumps, and rubella vaccine for the treatment of recalcitrant warts: A case series and review of literature

Objectives: To document the response of recalcitrant warts to intralesional measles, mumps, and rubella (MMR) vaccine. Materials and Methods: This case series reports the treatment response to intralesional MMR vaccine observed in 11 patients who attended the dermatology outpatient department with recalcitrant warts of more than 1 year duration. Only the largest wart was treated in each case. The intralesional treatment was repeated at an interval of 2 weeks. Results: Nine patients (81.9%) showed complete response to treatment. One patient did not return for treatment after two sessions (9.1%). One showed incomplete treatment response (9.1%). The adverse reactions noted among the 11 patients were pain (3/11, 27.3%) and secondary bacterial infection (1/11, 9.1%). Limitations: Results are based on a case series of 11 patients. Conclusion: Intralesional MMR vaccine was found effective and safe in the management of recalcitrant warts.