Fulminant varicella infection complicated by disseminated intravascular coagulation following influenza-A case report

Objectives: Varicella is common infectious disease mainly in childhood, usually is a mild, self-limited illness and complications are usually rare. The incubation period for this disease is generally 14- 16 days but may vary from 7 to 21 days. Varicella in the adults with comorbidities or immunosuppressed children may be severe and prolonged with complications. Method(s): A case report of a 6-year-old girl hospitalized for new-onset manifestations of disseminated vesicular exanthema, the manifestations of which occurred mainly on the chest, back, capillitium, oral cavity, and genital area. The child was suffering from abdominal, knee and lumbosacral pain at that time. The patient's history revealed that 10 days prior to the cutaneous manifestations, she had influenza with bronchopneumonia requiring oxygen therapy, steroids and antibiotics. Result(s): The condition progressed within 48 h, complicated by the development of multi-organ failure, coagulopathy with the development of disseminated intravascular coagulopathy over the course of antiviral, antibiotic and antifungal therapy. Laboratory parameters included high elevation of C-reactive protein, il-6, leukocytosis, neutrophilia and highly elevated liver enzymes. Varicella infection was confirmed by detection of herpes zoster virus - polymerase chain reaction (PCR) from vesicles. The patient received intravenous immunoglobulin therapy at a dose of 2 g/L and fresh frozen plasma, thrombocyte concentrate. The girl was intubated with analogization. Laboratory parameters subsequently revealed high anti CoV-2 positivity, high CoV-2 IgG positivity and negative CoV-2 IgM. The patient's condition did not preclude the course of multisystem inflammatory syndrome in children (MIS-C) corticosteroids were added to the treatment at a dose of 1 mg/kg weight. Patient's condition stabilized after 1 month. Discussion(s): Our case report presents an example of fulminant complicated life-threatening course of varicella. Even in common respiratory infections, we must think about the risk and consequences of coinfections and post-infectious complications such as in our case especially influenza and COVID-19.

The inspiratory activity of respiratory center and respiratory muscles strength after COVID-19.

The respiratory pump that provides pulmonary ventilation includes the respiratory center, peripheral nervous system, chest and respiratory muscles. The aim of this study was to evaluate the activity of the respiratory center and the respiratory muscles strength after COVID-19 (COronaVIrus Disease 2019). Methods. The observational retrospective cross-sectional study included 74 post-COVID-19 patients (56 (76%) men, median age - 48 years). Spirometry, body plethysmography, measurement of lung diffusing capacity (DLCO), maximal inspiratory and expiratory pressures (MIP and MEP), and airway occlusion pressure after 0.1 sec (P0.1) were performed. In addition, dyspnea was assessed in 31 patients using the mMRC scale and muscle strength was assessed in 27 of those patients using MRC Weakness scale. Results. The median time from the COVID-19 onset to pulmonary function tests (PFTs) was 120 days. The total sample was divided into 2 subgroups: 1 - P0.1 <= 0.15 kPa (norm), 2 - > 0.15 kPa. The lung volumes, airway resistance, MIP, and MEP were within normal values in most patients, whereas DLCO was reduced in 59% of cases in both the total sample and the subgroups. Mild dyspnea and a slight decrease in muscle strength were also detected. Statistically significant differences between the subgroups were found in the lung volumes (lower) and airway resistance (higher) in subgroup 2. Correlation analysis revealed moderate negative correlations between P0.1 and ventilation parameters. Conclusion. Measurement of P0.1 is a simple and non-invasive method for assessing pulmonary function. In our study, an increase in P0.1 was detected in 45% of post-COVID-19 cases, possibly due to impaired pulmonary mechanics despite the preserved pulmonary ventilation as well as normal MIP and MEP values.Copyright © Savushkina O.I. et al., 2023.

Physical and mental condition and medicine consumption of frontline medical staff of shelter hospitals in Shanghai during the fight against the epidemic of coronavirus disease 2019.

Objective To investigate the physical and mental condition and medicine consumption of medical staff of shelter hospitals in Shanghai during the fight against the epidemic of coronavirus disease 2019 (COVID-19). Methods A total of 144 frontline medical staff who fighting against the COVID-19 epidemic from a tertiary first-class hospital from Apr. 4 to May 12, 2022 were surveyed by questionnaires online. Their physical condition including body weight change before the medical work and one month later, sleep quality and the medicine consumption during the medical work were collected and analyzed. Results The mean body weight of frontline doctors before the medical work and one month later were (69.80+/-8.35) kg and (68.60+/-7.37) kg, while those of nurses were (55.36+/-8.27) kg and (53.80+/-7.38) kg, both showing a decreasing trend but without significant difference (all P0.05). A total of 63.89% (92/144) frontline medical staff suffered from insomnia, of which 27.08% (39/144) needed drug intervention. The top 5 common diseases among frontline medical staff were sleep disorder (63.89%, 92/144), skin injury (25.69%, 37/144), body pain (23.61%, 34/144), oral ulcer (13.19%, 19/144), and acute upper respiratory tract infection (9.72%, 14/144). A total of 155 medical staff used drugs, and the top 5 common drugs were skin application (16.77%, 26/155), Ganmao'an granule (12.26%, 19/155), zolpidem tartrate tablets (11.61%, 18/155), Kangfuxin liquid (11.61%, 18/155), and celecoxib capsules (8.39%, 13/155). Conclusion Frontline medical staff in shelter hospitals are prone to have body weight change, sleep disorder, skin injury, body pain, oral ulcer, acute upper respiratory tract infection and so on, which suggests that in future similar large-scale medical support, it is necessary to pay sufficient attention to the physical condition of frontline medical staff and provide them sufficient medicine.Copyright © 2022, Second Military Medical University Press. All rights reserved.

Teleconsultation in oral medicine during the covid-19 pandemic: experience of a Brazilian center

Introduction: Universities represent important Centers for public health assistance. However, in the context of the COVID- 19 pandemic, most Brazilian universities have suspended their academic activities and outpatient care. Objective(s): Describe how the Teleconsultation Program in Oral Medicine of the School of Dentistry, Brazil, remotely contributes to counseling dentistry on diagnosing oral lesions and providing guidance on treating patients in the North Macro-region of Minas Gerais state. Material(s) and Method(s): Teleconsulting takes place remotely;the professional sends by smartphone, via WhatsApp, the case report, clinical images, and complementary exams, if appropriate. Concerning this, the specialist team analyzes the clinical case and returns it to the professional sender, providing information and suggestions on the oral lesions' diagnostic assessment and clinical management. Result(s): Since the beginning of the program, in 19 months, dentists from 40 municipalities were counseled, which resulted in 287 teleconsultations;from these cases, 103 cases were conducted face-to-face consultations in our Oral Diagnosis Service, and 38 cases were hypothesized as malignant lesions in the oral cavity and had their medical treatment conducted and followed by a multidisciplinary team, when appropriate. Conclusion(s): Teleconsultation Program represents an important tool to strengthen the communication between professionals of public health, improve health work processes, and promote better clinical guidance in Oral Medicine.

Areas within the United States at the Highest Risk for African Swine Fever, Classical Swine Fever, and Foot-and-Mouth Disease Introduction

Domestic livestock production is a major component of the agricultural sector, contributing to food security and human health and nutrition and serving as the economic livelihood for millions worldwide. The impact of disease on global systems and processes cannot be understated, as illustrated by the effects of the COVID-19 global pandemic through economic and social system shocks and food system disruptions. This study outlines a method to identify the most likely sites of introduction into the United States for three of the most concerning foreign animal diseases: African swine fever (ASF), classical swine fever (CSF), and foot-and-mouth disease (FMD). We first created an index measuring the amount of potentially contaminated meat products entering the regions of interest using the most recently available Agricultural Quarantine Inspection Monitoring (AQIM) air passenger inspection dataset, the AQIM USPS/foreign mail, and the targeted USPS/foreign mail interception datasets. The risk of introduction of a given virus was then estimated using this index, as well as the density of operations of the livestock species and the likelihood of infected material contaminating the local herds. Using the most recently available version of the datasets, the most likely places of introduction for ASF and CSF were identified to be in central Florida, while FMD was estimated to have been most likely introduced to swine in western California and to cattle in northeastern Texas. The method illustrated in this study is important as it may provide insights on risk and can be used to guide surveillance activities and optimize the use of limited resources to combat the establishment of these diseases in the U.S.

Satisfaction of dentist users of the oral telediagnosis service in the COVID-19 pandemic, Minas Gerais, Brazil

Introduction: In early 2020, restrictions were established to control the transmission of COVID-19, such as the suspension of elective public health care. Dental teleservice has become an alternative to patient follow-up. In Brazil, the Federal Council of Dentistry published Resolution 226/2020, allowing the performance of dentistry at a distance. Objective(s): To assess dentists' satisfaction with the use of the oral telediagnosis service during the COVID-19 pandemic. Material(s) and Method(s): Cross-sectional and quantitative study. An online questionnaire was released to 636 dentists in the North of Minas Gerais, Brazil, between May and September 2022, with 298 respondents. The database was built using the Statistical Package for the Social Sciences, 24.0 software. This study was approved by the CEP (#5.267.570). Result(s): There was a predominance of dentists working in the public health network (86.2%;n=257). Most profession-als reported a drop in face-to-face calls during the pandemic (94.2%;n=281), and 86.2% (n=257) had losses from their activities. Teleservice resources were used during social isolation by 75.8% (n=226) of dentists, mainly for patient follow-up (63.7%;n=190). Consultation by phone was the main virtual method (63.7%;n=190). Regarding teleservice, 58.6% (n=119) of dentists realized the system was easy to use, and 50.2% (n=101) would like to continue using it after the pandemic. Conclusion(s): This is the first Brazilian study to assess dentists' satisfaction with teleservice. It is concluded that teleservice can contribute to early diagnosis and assistance by professional users.

Save the Trip to the Store: Sustainable Shopping, Electronic Word of Mouth on Instagram and the Impact on Cosmetic Purchase Intentions

The COVID-19 pandemic has forced many brands to stop using cosmetic testers to avoid the risk of spreading the infection, jeopardising the future of cosmetic testing. Consequently, consumers must find alternative methods to conduct their information searches and, more importantly, the prospects of shopping online without going to the store to test the product. With the enormous prospects of social media cosmetic electronic word of mouth (eWOM), it is imperative to examine the influence of cosmetic eWOM on social media and for cosmetic marketers to understand the antecedents that result in cosmetic consumers making a purchase. The adapted information adoption model was validated through structural equation modelling based on 341 eligible surveys. The results confirmed that information quality, source credibility, information usefulness, and information adoption are the key antecedents in eWOM on Instagram when investigating purchase intentions in the colour cosmetic industry. This study is one of the pioneers in empirically testing the relationship between information quality and source credibility on information usefulness and, subsequently, the relationship between information usefulness, information adoption, and purchase intentions in a western market based on the cosmetic industry. These new insights provide practical implications for a cosmetic marketer, suggesting the key variables leading to purchase intentions in cosmetic eWOM, which can be utilised in marketing techniques.

Antenatal anaesthetic assessment of parturients with BMI > 40 kg/m2

Introduction: Frimley Park Hospital criteria for referral to High-Risk Obstetric Anaesthetic Clinic (HROAC) included all parturients with BMI > 40. The COVID-19 pandemic necessitated HROAC becoming virtual. It was still possible to discuss risk and assess patients' airways, but not to reliably assess the likely ease of neuraxial techniques or cannulation. Observationally, little useful clinical information was gained, and airway problems rarely noted. An audit was planned to assess how often clinically useful information about the women's airways was gained during appointments. Method(s): HROAC database search for women referred with BMI > 40 with estimated date of delivery 20/04/20-03/04/21 to see whether any airway difficulties were predicted (Mallampati 3 or 4;limited neck movement;jaw slide B or C;limited mouth opening). Result(s): 82 women had BMI > 40, of which 3 were assessed as having a potentially difficult airway: two had BMI > 50 and one had retrognathism causing difficult airway prediction unrelated to her BMI of 41.7. One woman, BMI 58.7, was assessed as having a straightforward airway but her notes revealed her airway had been challenging to intubate in the past. One was assessed in video consultation as straightforward but an airway assessment during admission at the end of her previous pregnancy was Mallampti 3. Five women declined a video consultation. Discussion(s): In view of the minimal gain of clinically useful information and the routine presence of difficult airway kit for the obstetric emergency theatre, it was deemed safe and more relevant to make airway and neuraxial assessments on admission to labour ward rather than in the antenatal clinic for women with BMI<50. The assessment would therefore be made by the duty trainee anaesthetist who would be responsible for managing the patient, thus facilitating appropriate planning and communication if a woman with a challenging airway was identified. It is therefore also made at the very end of pregnancy when weight gain and its impact on airway is likely to be at its maximum. This approach, in conjunction with an antenatal information leaflet, and the ability of any obstetrician to refer to the HROAC, complies with the need for timely assessment of women as required by GPAS [1]. By formalising the assessment of women with high BMI on the labour ward it is hoped that patient safety and planning can be maximised.Copyright © 2023 Elsevier Ltd

Nanomedicine "New Food for an Old Mouth": Novel Approaches for the Treatment of COVID-19

Coronavirus disease (COVID-19) is an infectious disease caused by coronavirus. Devel-oping specific drugs for inhibiting replication and viral entry is crucial. Several clinical trial studies are underway to evaluate the efficacy of anti-viral drugs for COVID-19 patients. Nanomedicine formulations can present a novel strategy for targeting the virus life cycle. Nano-drug delivery systems can modify the pharmacodynamics and pharmacokinetics properties of anti-viral drugs and reduce their adverse effects. Moreover, nanocarriers can directly exhibit anti-viral effects. A number of nanocarriers have been studied for this purpose, including liposomes, dendrimers, exosomes and decoy nanoparticles (NPs). Among them, decoy NPs have been considered more as nanodecoys can efficiently protect host cells from the infection of SARS-CoV-2. The aim of this review article is to highlight the probable nanomedicine therapeutic strategies to develop anti-viral drug delivery systems for the treatment of COVID-19.Copyright © 2023 Bentham Science Publishers.

Oral cancer knowledge in adults evaluated through a phone survey in the context of SARS-COV2 pandemic

Introduction: Oral cancer is Colombia's 8th most common cancer, with an estimated survival rate of 52%. Lack of knowledge and awareness about oral cancer and its risk factors is associated with a delay in diagnosis. Objective(s): To evaluate adults' oral cancer knowledge through a phone survey in the context of the SARS-COV2 pandemic. Material(s) and Method(s): A cross-sectional questionnaire survey was conducted by phone during the COVID-19 pandemic on 268 patients attending at the dental school of Universidad de Antioquia, years 2020-2021. The collected data were analyzed using SPSS software. Result(s): The mean age was 58.9 years. 58.6% of participants had heard about oral cancer. social media was the primary source of information for 42% of participants, and 96.7% considered the screening important. Most patients did not feel worried (54.5%), fearful (59.7%), or anxious (56.3%) in case they were submitted to a screening for early detection of oral cancer. Lower socioeconomic status and educational level are correlated with lower awareness of oral cancer. The dimensions of experience and attitude towards screening were not associated with sociodemographic variables. Conclusion(s): The knowledge of oral cancer is still poor and is related to low socioeconomic and educational levels. However, this association was not observed in the attitude and experience dimensions toward screening for oral cancer. Therefore, there seems to be a need for more educational programs about knowledge of oral cancer, especially in socially disadvantaged groups, considering that there are no barriers related to screening.

Evaluation of the bactericidal effect of UV-LED light on alginate impressions.

The oral cavity houses a large number of microorganisms that are potential pathogens, such as cytome-galovirus, hepatitis B virus (HBV), hepatitis C virus, herpes simplex virus types 1 and 2, human immuno-deficiency virus, mycobacterium tuberculosis and currently with the appearance of the SARS COV-2 that causes covid-19, the dental community must take stricter measures in its protection protocols against diseases. To evaluate its germicidal efficacy, ultraviolet light was applied with different exposure times on the alginate dental impressions, immediately after having taken the impression, which when it came into contact with the oral cavity of the patient is contaminated. As a result, a decrease in size and quantity of the bacterial colonies was observed in most of the samples in which the UV LED light was applied at 10 and 15 minutes of exposure. Some samples showed less bacterial growth even after 5 minutes of exposure. All this confirms its germicidal capacity thanks to its 245 nm ultraviolet spectrum that affects the DNA and RNA chain of microorganisms since it is the wavelength of maximum absorption of its molecule, eliminating its reproductive and survival capacity. The advantages it offers such as its small size, easy to handle and install, that it does not require constant maintenance, low acquisition cost;its constant high intensity light that does not generate any increase in temperature, makes it an excellent disinfectant auxiliary that can be incorporated into dental clinics.Copyright © 2023, Ediciones Avances S.L.. All rights reserved.

Lymphoproliferation- a clue towards an underlying monogenic disorder of immune dysregulation- a retrospective analysis from a single center in India

Background: Lymphoproliferation is the persistent proliferation of lymphoid cells and it's incidence in inborn errors of immunity varies from 0.7 to 18%. Material(s) and Method(s): This is a retrospective analysis of patients referred to the department of Immunology, B. J. Wadia Hospital for Children, Mumbai between March 2017 to December 2022. Inclusion criteria consisted of 3 months duration of significant lymphadenopathy and/or splenomegaly or history of lymphoma. The clinical characteristics, laboratory and molecular findings of the included patients were analyzed. Result(s): A total of 66 patients were included. There was a male preponderance with male:female ratio of 25:8. Median age of onset of lymphoproliferation was 4.75 years(Range 1 year to 60 years). Splenomegaly was seen in 75%. Infections included recurrent pneumonia (14/66), recurrent ear infections(5/66), COVID(4/66), one episode of pneumonia(6/66), herpes zoster(3/66), recurrent subcutaneous abscess (3/66), abdominal koch(3/66), chronic sinusitis(2/66), dermatophytosis(2/66), esophageal candidiasis(2/66), recurrent malaria(1/66), recurrent varicella(1/66), cryptococcal meningitis(1/66), gram negative sepsis(1/66), BCG adenitis(1/66), pseudomonas osteomyelitis(1/66), impetigo (1/66), pseudomonas urinary tract infection (1/66), chicken pox(1/66), herpes keratitis(1/66), dengue(1/66), Other manifestations included Evans plus phenotype(10/66), Evans phenotype(8/66), Autoimmune hemolytic anemia(5/66), bronchiectasis(5/66), Type 1 diabetes(3/66), hyper reactive airway disease(2/66), inflammatory bowel disease(4/66), autoimmune thrombocytopenia(2/66), stroke(3/66), hemophagocytic lymphohistiocytosis(2/66), hypertriglyceridemia(2/66), hypothyroidism(2/66), celiac disease(1/66), Type 2 diabetes(1/66), autoimmune encephalitis(1/66), autoimmune hepatitis(2/66), anti-parietal cell antibody(1/66), arthritis(1/66), autoimmune enteropathy(1/66), systemic lupus erythromatosus(1/66), primary biliary cirrhosis requiring liver transplant(1/66), nephrotic syndrome(1/66), lymphoedema(1/66), hypersplenism(1/66), recurrent oral ulcers(1/66), gout(1/66), dermatitis(1/66), ovarian teratoma(1/66), alopecia areata(1/66). Hodgkin's lymphoma(HL) was the most common malignancy(9/66), followed by non Hodgkin lymphoma(NHL)(6/66), transformation from NHL to HL(1/66), Burkitt to T-cell lymphoma(1/66), HL to DLBCL(1/66), HL to anaplastic T-cell lymphoma(1/66). EBV driven lymphoproliferation was seen in biopsy of21/66. Genetic testing showed mutations in LRBA(11/66), PIK3CD(5/66), CTLA4(3/66), TET2(2/66), IL2RA (1/66), IL12RB1(1/66), BACH2(1/66), PRKCD(1/66), TNFSFR13B(1/66), TNFAIP3(1/66), FAS(2/66), FASL(1/66), Caspase8(1/66), CARD11(1/66), RTEL1(1/66), AICD(1/66), PIK3R1(1/66), IKBKB(1/66). Treatment included IVIG, chemotherapy, rituximab, sirolimus, abatacept, HSCT. Conclusion(s): All children with persistent lymphoproliferation, with or without autoimmunity and/or infections should be worked up for an underlying monogenic disorder of immune dysregulation. Lymphomas presenting at abnormal site and/or age, relapse and EBV driven lymphomas require further evaluation. Presence of monogenic cause helps in providing targeted therapy.Copyright © 2023 Elsevier Inc.

Epidemiological and clinics characteristics of 414 cases of oral lesions and sensorial functions of COVID-19 in Brazil

Introduction: Several studies have evaluated the occurrence of oral lesions and changes in sensory functions in patients positive for COVID-19. Objective(s): To evaluate the manifestations of COVID-19, emphasizing olfactory and gustatory changes, xerostomia, and oral lesions. Material(s) and Method(s): A cross-sectional and observational study was conducted. Approved by the Institutional Ethics Committee (#46151121.6.0000.5141). All patients were diagnosed by reverse transcription-polymerase chain reaction assay (RT-PCR) and considered to have mild symptoms, according to the latest WHO joint report. The patients were evaluated at a reference Service for COVID-19 in Minas Gerais, Brazil. The oral cavity was evaluated for each patient on the second and seventh days. Result(s): A total of 414 patients older than 18 years were evaluated. One hundred thirty-nine presented at least one of the studied conditions, oral lesions (19.08%) were the most frequently observed, followed by gustatory disorders (18.11%), xerostomia (14.25%), and olfactory dysfunction (14%). Among the oral lesions, there were various anatomical locations and clinical presentations. The occurrence involving lips and tongue represented 49 oral lesions, the most prevalent being, respectively, ulcerations (n=51), candidiasis (n=8), and erythema or red plaques (n=7). Fifty patients died. Conclusion(s): This study represents, to date, the largest case series of oral lesions in Brazilian patients with COVID-19, and oral alterations were observed in an expressive percentage of patients with COVID-19. However, it cannot be concluded that SARS-CoV-2 directly causes them.

Online survey about oral manifestations of COVID-19

Introduction: Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 (Coronavirus type 2 causing severe acute respiratory syndrome) presents systemic manifestations such as fever, anosmia, cough, sore throat and headache, dyspnea, tiredness, malaise, diarrhea. There are reports of developing dysgeusia, xerostomia, and vesiculobullous lesions as oral manifestations related to COVID-19. Objective(s): To identify the most prevalent oral manifestations associated with COVID-19 in a group of Paraguayans. Material(s) and Method(s): An electronic survey was used from January to March 2022. Data were presented as frequencies and percentages and analyzed using the chi2 test. Statistical analysis was performed with R software version 4.0.3. Result(s): The sample consisted of 478 people, most female from 15 to 34 years old. 65.48% stated that they had had at least one oral symptom or sign during COVID-19. The loss in the sensation of bitter tastes (34.31%), the alteration of the taste of food (32.43%), and the loss of sweetness (32.01%) were the most prevalent symptoms. In addition, it was found that among the people who developed moderate to severe COVID-19, there was a more significant number (77.78%) of oral manifestations compared to the participants who developed it mildly (63.92%) (chi2;p= 0.044). Conclusion(s): More than half of the respondents presented oral manifestations, more frequent in those who developed moderate to severe COVID-19. Results will serve as a basis for future research and thus strengthen the surveillance of this disease.

Computational Investigation of Hand Foot Mouth Disease Dynamics with Fuzziness

The first major outbreak of the severely complicated hand, foot and mouth disease (HFMD), primarily caused by enterovirus 71, was reported in Taiwan in 1998. HFMD surveillance is needed to assess the spread of HFMD. The parameters we use in mathematical models are usually classical mathematical parameters, called crisp parameters, which are taken for granted. But any biological or physical phenomenon is best explained by uncertainty. To represent a realistic situation in any mathematical model, fuzzy parameters can be very useful. Many articles have been published on how to control and prevent HFMD from the perspective of public health and statistical modeling. However, few works use fuzzy theory in building models to simulate HFMD dynamics. In this context, we examined an HFMD model with fuzzy parameters. A Non Standard Finite Difference (NSFD) scheme is developed to solve the model. The developed technique retains essential properties such as positivity and dynamic consistency. Numerical simulations are presented to support the analytical results. The convergence and consistency of the proposed method are also discussed. The proposed method converges unconditionally while the many classical methods in the literature do not possess this property. In this regard, our proposed method can be considered as a reliable tool for studying the dynamics of HFMD.

The Effect of FOXP3+Regulatory T Cells on Infectious and Inflammatory Diseases

CD4+CD25+FOXP3+regulatory T cells (Tregs) contribute to the maintenance of immune homeostasis and tolerance in the body. The expression levels and functional stability of FOXP3 control the function and plasticity of Tregs. Tregs critically impact infectious diseases, especially by regulating the threshold of immune responses to pathogenic microorganisms. The functional regulatory mechanism and cell-specific surface markers of Tregs in different tissues and inflammatory microenvironments have been investigated in depth, which can provide novel ideas and strategies for immunotherapies targeting infectious diseases.Copyright © 2021. All rights reserved.

BTKi-treated CLL patients have Favourable survival outcomes but concerning levels of second malignancies and COVID-related mortality

Introduction: Bruton's tyrosine kinase inhibitors (BTKi) are used extensively within the NHS to treat specific B-cell malignancies with patients stopping BTKi usually due to adverse events or disease progression. The objective of this study was to analyse effectiveness of BTKi therapy for chronic lymphocytic leukaemia (CLL) at our centre compared to previously published real-world data from the UKCLL Forum (Follows et al, Blood 2019). In addition, we investigated treatment-related adverse events (AE) and second malignancies. Method(s): This is a single-centre retrospective study of 112 CLL patients treated with a BTKi for a minimum of 4 weeks between 2014 and 2022 (ibrutinib n = 71, acalabrutinib n = 38, zanubrutinib n = 3). Treatment was first line (n = 39), second line (n = 44) and 3+ line (n = 29). Patient demographics, duration of BTKi therapy, Aes, discontinuation reasons and second malignancies were collected. Aes were compared with a parallel cohort of 53 non-CLL BTKi-treated patients. Result(s): Median age starting treatment was 73 years, and 71% were male. Primary outcomes were discontinuation-free survival (DFS) and overall survival (OS). With a median follow-up of 3.90 years, the median DFS was 4.18 years (95% CI: 3.52-4.91) with a median OS of 6.35 years (95% CI: 5.52-NA). These compare favourably with previous UKCLL forum data (median DFS = 2.79 years;median OS = 4.66 years), although our patients were more likely to receive BTKi earlier in treatment (3rd line or beyond: 26% of our patients vs. 78% in the UKCLL Forum). The most common Aes included bleeding, cytopenia, infection, cardiac events and mouth ulcers, with 21% stopping BTKi for CLL due to Aes whilst 15% of non-CLL BTKi patients stopped due to an AE. Second malignancies were reported in 49% of CLL patients, yet only 34% of non-CLL patients. Among patients with a confirmed cause of death, infection was the most common cause (39%), followed by CLL (33%), then second malignancy (18%). Of the 31 deaths in 2020 and 2021, 7/31 (23%) were due to, or in association with COVID-19 infection. No COVID-19 deaths were associated with BTKi in non-CLL patients. Conclusion(s): We demonstrate a favourable real-world DFS and OS for BTKi-treated CLL patients although a high number of patients still stop BTKi due to Aes. The very high incidence of second malignancies for all BTKi-treated patients and COVID-19 and infection-related deaths for CLL patients is concerning. As CLL is known to associate with high levels of second cancers, it remains unclear whether BTKi use increases this risk further.

Special Issue: COVID-19, part 3. (Special Issue: COVID-19, part 3.)

This special issue contains 63 articles focusing on the oral manifestations of COVID-19. The articles offer a comprehensive overview of the current knowledge on the subject, encompassing the epidemiology, clinical presentation, diagnosis, and management of oral lesions associated with COVID-19. Additionally, the articles explore the potential role of the oral cavity in COVID-19 transmission, along with the impact of the pandemic on oral health care delivery.