Successful Trastuzumab-Deruxtecan Rechallenge After Interstitial Lung Disease: A Case Report / 한국유방암학회지

Trastuzumab deruxtecan (T-DXd) is used to treat human epidermal growth factor receptor 2-positive advanced breast cancer. Interstitial lung disease (ILD) is a severe adverse event associated with T-DXd. Current guidelines recommend permanent discontinuation of T-DXd after Common Terminology Criteria for Adverse Events (CTCAE) grade ≥ 2 ILD. Here, we describe a case of successful rechallenge with T-DXd after CTCAE grade 2 treatmentinduced ILD. After discontinuation of T-DXd, ILD was treated with steroids until complete resolution. Given the initial beneficial antitumor response, retreatment was discussed during disease progression. In a shared decision with the patient, T-DXd was restarted at the lowest registered dose, along with low-dose steroids. ILD did not reoccur. Importantly, both clinical and radiological responses to the treatment were observed, with an improvement in the patient’s quality of life. This case demonstrates that retreatment with T-DXd after a grade 2 ILD event is feasible and yields clinical benefit.

Factors associated with COVID-19 vaccine acceptance among adult patients in primary care clinics in Laguna, Las Piñas and Parañaque: A cross sectional study

Background@#Since its surfacing in 2019, COVID-19 has spread all over the world and became an international concern. Vaccines against COVID-19 are expected to be the key in controlling this pandemic. To achieve this, studying factors that affect COVID-19 vaccine acceptance is crucial in order to increase the vaccine uptake rate of Filipinos to attain herd immunity.@*Objective@#The study aimed to determine the factors affecting COVID-19 vaccine acceptance among adult patients in primary care clinics in Laguna, Las Piñas and Parañaque.@*Methods@#This cross-sectional study was conducted last June 2021 with 137 adult patients from 6 clinics. The participants were given self-administered questionnaires containing items on sociodemographic profile and perception on vaccines. MS Excel and IBM SPSS were used for statistical analysis. Categorical variables were summarized as frequencies and percentages and continuous variables as means and standard deviations. Chi square was used to compare outcomes. Variables with statistically significant differences (p-value of <0.05) were included in multinomial regression analysis to determine association with vaccine acceptance.@*Results@#Residence (p=0.0166), educational level (p=0.017), perceived effectiveness of vaccines to prevent and control COVID-19 (p=0.001), safety (p=0.001), doctor’s recommendation (p=0.039), risk of being infected (p=0.025) and refusal of any type of vaccine in the past (p=0.003) were associated with COVID-19 vaccine acceptance.@*Conclusion@#Through this study, the authors found that most of the respondents are willing to get vaccinated regardless of their sociodemographic characteristics. Concerns about vaccine availability and accessibility can hinder the promotion of vaccine uptake in the future. This study can be used as a basis for development and planning of COVID -19 vaccination programs.

Analysis of dengue cases using geographic information systems: Evidence from Baguio City, Philippines

@#Dengue is a global health issue and is also regarded as one of the major public health concerns in the Philippines. Presented in this paper is the application of a geographic information system (GIS) in mapping dengue cases in Baguio City. A descriptive research design was utilized and mapped dengue cases were reconciled with environmental correlates such as land cover, housing information (independent, mixed, or interconnected), hydrology (water bodies and canals), urbanization level (urban or rural), elevation, soil, and land surface temperature. Moreover, demographic factors and practices were utilized for further analysis. Results show that interconnected housing, urbanization, land surface temperature, hydrology, and population density are predictors of dengue cases in Baguio City with the predictive power of 0.3810 (strong), 0.3426 (strong), 0.2509 (medium), 0.1675 (medium), and 0.1323 (medium), respectively. In the context of dengue, several data gaps in health information systems exist. Although the Manual of Procedures for the Philippine Integrated Disease Surveillance and Response (PIDSR) published by the Department of Health (DOH) of 2014 provides a detailed guide in the management and surveillance of communicable disease, the use of GIS was noted to be unspecified. Using GIS provides the possibility of harmonizing several data sets to better inform policymakers.

Tripod position as a novel adjunct clinical management of moderate to severe ARDS in COVID-19 patients: A case series and review

Objective@#The World Health Organization (WHO) recommends prone positioning for mechanically ventilated COVID-19 patients with Acute Respiratory Distress Syndrome (ARDS) to improve oxygenation. Subsequently, researchers facilitated the position to non-intubated COVID-19 patients as early management which showed significant improvement but with discerned limitations. Tripod position is explored as an alternative exhibiting promising results. This present study describes a case series of four COVID-19 patients with moderate to severe ARDS who demonstrated considerable breakthrough.@*Methods@#Four COVID-19 cases of moderate to severe ARDS were instructed to do tripod positioning as long as they can tolerate while under close supervision.@*Results@#An hour after assuming tripod position, all four patients presented a decrease in respiratory rate, increase in peripheral oxygen saturation, and increase in partial oxygen saturation in arterial blood gas. The assumed position was maintained by four patients without discomfort and was maintained with a mean of 12 - 20 hours per day. @*Conclusions@#Our findings confirmed that tripod position is advantageous to non-intubated COVID-19 patients with moderate to severe ARDS and may delay or prevent invasive mechanical ventilation. The position also manifested tolerance to extended duration which permitted time for the medical team to focus on managing their disease in its entirety. Nevertheless, certain aspects such as contraindication, side effects, and other adverse events that may occur have yet to be sufficiently clarified and investigated.

Proton Pump Inhibitors and Corticosteroids as Synergistic Risk Factors for Candida Esophagitis.

Introduction: Inhaled & systemic steroids are one of the well-documented risks factors for Candida esophagitis. However, the role of gastric acid suppression remains controversial. Methods: We conducted a retrospective case-control study of 420 patients consisting of 84 cases of Candida esophagitis and 336 matched controls. Our cohort was gathered from subjects evaluated from 2001 to 2012. The diagnosis of Candida esophagitis was based on endoscopic and/or histological criteria. Results: On univariate analysis, proton pump inhibitors were associated with higher risk (OR = 2.14; 95 % CI: 1.30 to 3.54); steroid use also increased the risk (OR = 3.55; 95% CI: 2.10 to 6.00). Furthermore, concurrent use of proton pump inhibitors & steroids substantially raised this risk (OR = 13.8; 95% CI 5.07 to 37.5), suggesting a synergistic effect. When adjusted for covariates (cancer, chemotherapy/radiation, antibiotic use, hypothyroidism, anemia, chronic liver disease & diabetes), anemia decreased the odds ratio for proton pump inhibitors to 1.67 (95% CI 1.02 to 2.75) and steroids to 1.69 (95% CI to 1.03 to 2.87). Hypothyroidism also substantially reduced the observed risk associated with steroid use. However, neither anemia nor hypothyroidism reduced the odds ratio for combined use of steroids and proton pump inhibitors. Conclusions: Our data suggests that patients who have been treated with steroids or proton pump inhibitors are at an increased risk for developing Candida esophagitis. Our data also suggests that steroids and proton pump inhibitors act synergistically to greatly increase the likelihood of Candida esophagitis.

BK virus: microbiology, epidemiology, pathogenesis, clinical manifestations and treatment

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Background: BK virus infection is common but is usually asymptomatic. However, it can become life threatening as severe hemorrhagic cystitis (HC) or the polyomavirus-associated nephropathy (PVAN) particularly in immune compromised and transplant recipients. Some investigators have studied the pathophysiology and there are anecdotal and uncontrolled studies of therapy with few conclusions allowing treatment guidelines. Objectives: Summarize literature review of current knowledge concerning the nature, epidemiology, pathophysiology, diagnosis and treatment of this common virus infection. Results: HC is a not uncommon and often misdiagnosed infection from BK virus. It is usually self limited but can become life threatening in immune compromised patients. PVAN threatens survival of transplanted kidneys and is difficult to differentiate from rejection without sophisticated molecular diagnostic technology. We have sufficient information for making a diagnosis of BK virus disease by using clinical, serological and molecular technology. Studies using manipulation of immunosuppression and a variety of antiviral agents, including cidofovir, leflunomide, intravenous immunoglobulin, vidarabine, fluroquinolones, have been published but most were uncontrolled reports of few cases. Cidofovir offers some promise but more must be learned before there is hope for evidence-based treatment guidelines.

Studies of recombinant streptococcal pyrogenic exotoxin B/cysteine protease (rSPE B/SCP) in the skin of guinea pigs & the release of histamine from cultured mast cells & basophilic leukocytes.

BACKGROUND & OBJECTIVES: Streptococcal pyrogenic exotoxin B/streptococcal cysteine protease (SPE B/SCP) is considered to be one of the virulence factors of Streptococcus pyogenes (S. pyogenes) which causes serious diseases such as severe invasive infections and streptococcal toxic shock syndrome (STSS). There are no reports on the histamine releasing activity of SPE B/SCP from mast cells, although several biological activities have been studied. It is not clear whether SPE B/SCP have the superantigenic activity. We studied whether SPE B/SCP plays as a pathogenic factor in streptococcal infections and STSS through a histamine releasing activity. METHODS: Human mast cells and basophils were generated from CD34 positive cells isolated from cord blood and cultured in the presence of rIL-6, stem cell factor and/or rIL-3. The capacity of increasing capillary permeability of recombinant SPE B/SCP (rSPE B/SCP) was studied by using the skin of guinea pigs. Mitogenic activity to human T-cells of rSPE B/SCP was studied by incorporation of (3)Hthymidine. The levels of histamine in the plasma of patients with STSS and controls were measured by ELISA kit. RESULTS: rSPE B/SCP induced increased capillary permeability in the skin of guinea pigs, but both SPE A and SPE C did not exhibit such activity. Histamine was released from cultured human mast cells stimulated with rSPE B/SCP. The rSPE B/SCP did not exhibit mitogenic activity to human T-cells. Three of the 7 patients with STSS showed higher levels of plasma histamine than those of normal subjects. INTERPRETATION & CONCLUSION: The results suggested that increased capillary permeability and histamine release from mast cells induced by rSPE B/SCP might be involved in STSS and/or streptococcal infection of skin and mucous membrane.

The immunological and virological response in human immunodeficiency virus type-1 (HIV-1) infected Indian individuals on haart therapy: A one-year follow up study.

Currently, antiretroviral therapy has become more affordable even in developing countries and it is being used in India. Fifteen HIV-1 infected individuals, who were on highly active antiretroviral therapy (HAART), were followed up for an average period of one year. The plasma viral load and CD4+ T cell estimation done at mean intervals of 5 months and 11 months after initiation of therapy showed a good response to therapy in 14 (93%) individuals.

Performance evaluation of four different kits available in the Indian market, for the rapid detection of HIV antibody.

The performance of four rapid human immunodeficiency virus (HIV) antibody screening assays was evaluated on an established panel of samples. All the assays showed 100% sensitivity and specificities in the range of 98.6-100%. These tests can safely be used for screening at centres in India where facilities are limited.