ABSTRACT
Tumor immunotherapy is an important clinical strategy for the treatment of various solid and hematological malignancies, and its use is on the rise. Immune checkpoint inhibitors (ICIs) are immunotherapies that boost anticancer immune responses by targeting receptors on the surface of T-lymphocytes. Two important ICIs are anti-programmed death ligand-1 (anti-PD-L1) monoclonal antibodies and anti-cytotoxic T-lymphocyte-associated antigen-4 (anti-CTLA-4) monoclonal antibodies. Tremelimumab (anti-CTLA-4) and durvalumab (anti-PD-L1) have been shown to be effective monotherapies. However, their combination has demonstrated effective and encouraging antitumor activity with manageable safety in patients with unresectable hepatocellular carcinoma. We present the case of an 80-year-old male with hepatocellular carcinoma who had undergone drug-eluting bead transarterial chemoembolization (DEB-TACE) on three occasions and had been started on a combination of ICIs, durvalumab, and tremelimumab. He subsequently developed various immune-related adverse effects in different organ systems, including hepatic and cardiovascular complications. Appropriate treatment was administered, but ultimately, he passed away. We aim to discuss the initial evaluation for suspected immune-related adverse events, specifically those related to myocarditis and its various manifestations, prognosis, and treatment.
ABSTRACT
OBJECTIVE: To establish the association between malocclusion severity and orthodontic case complexity as assessed by the Dental Aesthetic Index (DAI) and the American Board of Orthodontics Discrepancy Index (ABO-DI), respectively. DESIGN: Cross-sectional study. SETTING: Pre-treatment dental casts and radiographs from 500 individuals (294 women and 206 men; mean age = 26.06 ± 11.58 years) were randomly selected from the orthodontics department of a private university. METHODS: Malocclusion severity was assessed using DAI and case complexity was evaluated with ABO-DI. Three previously calibrated operators performed the measurements. Spearman's correlation analysis, Mann-Whitney U test, Kruskal-Wallis test and a linear generalised model were used for statistical evaluation (P < 0.05 was considered significant). RESULTS: Although the correlation (r = 0.45; P < 0.0001) between malocclusion severity and case complexity was moderate, strong evidence of an association (P < 0.001) between dichotomised DAI and ABO-DI total scores was observed. The linear generalised model showed that for each point of increase in DAI score, the ABO-DI score increased an average of 0.3624 points (P < 0.0001). CONCLUSION: An association between malocclusion severity and case complexity is suggested. A linear generalised model could be used to predict the complexity of the case from the malocclusion severity (DAI score).
