ABSTRACT
Introduction: The rapid spread of the COVID-19 pandemic has become a source of concern for dental students in recent years, as long as they are exposed to an increased risk of infection due to close contact with patients. Objective: To determine the level of epidemiological, preventive and healthcare-related knowledge about COVID-19 in dental students during their last academic year from three Peruvian universities. Methods: Descriptive, analytical and cross-sectional study, whose sample consisted of 219 dental students in their last academic year from Federico Villarreal National University, Peruvian Wings University and Inca Garcilaso de la Vega University in Lima, Peru. The instrument was a questionnaire of twenty closed questions on epidemiological, preventive and healthcare knowledge about COVID-19. The results were classified in three levels: low, medium and high. Central tendency measures and the ANOVA test with Tukey's adjustment test were performed for independent pairwise comparisons. In addition, the Spearman correlation test was applied to control the confounding variables (gender and age). Results: The students, in general, presented epidemiological (high), preventive (low) and healthcare (medium) knowledge, accounting for 86.3%, 53.4% and 63.5%, respectively. The global average score was 14.80±1.98. The students from Federico Villarreal National University presented significantly lower scores than the students from Inca Garcilaso de la Vega University (P≤0.001) and Peruvian Wings University (P=0.002). Conclusion: Knowledge deficiencies were found regarding preventive and care measures for COVID-19 control;therefore, it is important to train dental students with constant educational sessions and training programs on infection control practices regarding COVID-19. © 2021, Editorial Ciencias Medicas. All rights reserved.
ABSTRACT
Introduction: Stage IIIB-IV non-small cell lung cancer patients with mutations in the EGF receptor gene (EGFR) usually derive clinical benefit from to tyrosine kinase inhibitors (EGFR TKIs) but ultimately relapse. In preclinical studies, we have showed that anti-EGF antibodies generated by vaccination significantly increased the antitumor activity of TKIs in EGFR-mut cell lines, blocking EGFR, Erk1/2, Akt and STAT3 activation and delaying emergence of resistance. Based on these findings, the EPICAL trial was initiated (ClinicalTrials.gov number, NCT03623750). Methods: The EPICAL was a single arm, phase 1b, single arm study to evaluate the safety and efficacy of first line anti-EGF vaccination combined with afatinib. The trial enrolled advanced NSCLC patients with sensitizing EGFR mutations confirmed in a central laboratory. Patients received 40 mg/day of afatinib and five intramuscular anti-EGF vaccinations every 14 days and then every three months until progression. Four medical centers in Spain participated, with a target enrollment of 30 patients. However, the COVID-19 outbreak forced an early termination of the study in March 2020 with only 23 patients included. Serial blood samples were collected and used to evaluate the levels of selected growth factors by ELISA and biological activity by addition of sera to in vitro cultures of EGFR-mut cells followed by Western blotting. Results: Of the 23 patients enrolled in the trial, nine (39%) had exon 19 in-frame deletions, twelve (52%) exon 21 substitutions and two (9%) exon 18 missense mutations. Combination treatment was well tolerated and no SAES related to anti-EGF vaccination were reported. Objective response and disease control rates were 78.3% (95%CI=53.6-92.5) and 95.7% (95%CI=78.1-99.9), respectively. At data cut-off, with a median follow-up of 11.4 months (95%CI=8.1-15.2), the median progression-free survival was 17.4 months (95% CI=13.22-NA) and median survival not reached (95% CI=15.21-NA). Median PFS for patients with exon 19 deletions and exon 21 point mutations were 13.9 months (95%CI=8.7-NR) and 17.4 months (95%CI=13.2-NR), respectively. Three months after initiation of treatment, high titers of anti-EGF antibodies were detected in all patients and serum EGF and TGFα levels were found to be significantly lower compared to baseline levels. Finally, treatment with post-vaccination patient’s sera inhibited EGFR, AKT and ERK1/2 phosphorylation in EGFR-mut cells growing in vitro. Conclusion: The combination of an anti–EGF vaccine with afatinib is well tolerated and induces a sustained immunogenic effect. Vaccination against EGF might enhance the clinical efficacy of EGFR TKIs. Keywords: anti-EGF vaccination, EGFR-mutant non-small cell lung cancer, EGFR inhibitors