Evolving Role of Daratumumab: From Backbencher to Frontline Agent

Approval of daratumumab (DARA), an IgGk1 monoclonal antibody targeting CD38, for the treatment of relapsed/refractory multiple myeloma as monotherapy in November 2015 expanded the therapeutic armamentarium for multiple myeloma. Widespread tissue expression of CD38 combined with potent immunomodulatory activity provides a rationale for the expanding use of DARA and potential new marketing authorizations. Novel combinations of DARA have been built on the basis of preclinical data of synergy and overcoming DARA resistance. Newer delivery strategies have led to the administration of DARA in community settings. Despite a remarkable tolerability profile in elderly myeloma patients, DARA use increases the risk of infections, particularly virus reactivation, requiring close monitoring and/or prophylaxis. We aim to provide an in-depth review of the mechanisms of action, resistance, and synergies of DARA and to highlight its current clinical uses and potential future perspectives. Laboratory issues with the use of DARA and their mitigation strategies are also discussed.     

Mechanized laundering of mops for floor cleaning can reduce infection transmission through hospital floor

PurposeHospital floors are underappreciated reservoir for microbes; therefore, floor cleaning should warrant reduction of microbial load for decreasing risk of infection transmission and has to be aesthetically acceptable. It was aimed to study the impact of mechanized laundering of floor mops in reducing microbial load compared to manual washing.MethodsAn interventional study was conducted from January to July 2019 in various inpatient areas of All India Institute of Medical Sciences, New Delhi. Culture of floor mops were taken after manual washing (pre-intervention) and mechanized laundering(intervention). During intervention, mops were equally divided into two piles, with one pile soaked in sodium hypochlorite for 15–20 min before mechanized laundering and other were put directly for mechanized laundering. Bacterial load in floor mops was observed in each group.ResultsSignificant difference (P Value 0.001) in bacterial load was observed in manually washed (502 cfu/plate) and mechanized laundering (278 cfu/plate) of floor mops. Presoaking of floor mops with sodium hypochlorite (262 cfu/plate) did not show any significant difference (P-value 0.59) in reduction of bacterial load compared to mops which were cleaned using mechanized laundering (294 cfu/plate). The bacterial load of floor mops which were manually washed showed increase in mean value of microbial load from 609 cfu/plate from day one to 4015 cfu/plate on day five.ConclusionMechanized laundering of floor mops standardizes the mop cleaning process and brings down the microbial load significantly compared to manual washing. Disinfection of floor mops before mechanized laundering using sodium hypochlorite did not have significant impact on reduction of microbial load.     

Prevalence of SARS-CoV-2 IgG antibodies and their association with clinical symptoms of COVID-19 in Estonia (KoroSero-EST-1 study)

PurposeIn Estonia, during the first wave of COVID-19 total number of cases confirmed by PCR was 13.3/10,000, similar in most regions, including capital Tallinn, but in the hotspot of Estonian epidemic, an island Saaremaa, the cumulative incidence was 166.1/10,000. We aimed to determine the prevalence of SARS-CoV-2 IgG antibodies in these two regions, symptoms associated with infection and factors associated with antibody concentrations.MethodsParticipants were selected using stratified (formed by age decades) random sampling and recruited by general practitioners. IgG or neutralizing antibodies were determined from sera by four assays. Symptoms associated with seropositivity were analyzed by multiple correspondence analysis, antibody concentrations by multiple linear regression.ResultsTotal of 3608 individual were invited and 1960 recruited from May 8 to July 31, 2020. Seroprevalence was 1.5% (95% confidence interval (CI) 0.9–2.5) and 6.3% (95% CI 5.0–7.9), infection fatality rate 0.1% (95% CI 0.0–0.2) and 1.3% (95% CI 0.4–2.1) in Tallinn and Saaremaa, respectively. Of seropositive subjects 19.2% (14/73) had acute respiratory illness. Fever, diarrhea and the absence of cough and runny nose were associated with seropositivity in individuals aged 50 or more years. IgG, but not neutralizing antibodies concentrations were higher if fever, difficulty breathing, shortness of breath, chest pain or diarrhea was present, or hospitalization required.ConclusionSimilarly to other European countries the seroprevalence of SARS-CoV-2 in Estonia was low even in the hotspot region Saaremaa suggesting that majority of population is susceptible to SARS-CoV-2. Focusing only on respiratory symptoms may delay accurate diagnosis of SARS-CoV-2 infection.     

UAA-AAUS guideline for M. genitalium and non-chlamydial non-gonococcal urethritis

Non-chlamydial non-gonococcal urethritis (NCNGU) is defined as urethritis with neither Neisseria gonorrhoeae nor Chlamydia trachomatis. Possible causative agents of NCNGU include Mycoplasma genitalium, Ureaplasma urealyticum, Ureaplasma parvum, Mycoplasma hominis, Trichomonas vaginalis, and so on. Among these microorganisms, the pathogenicity of M. genitalium and T. vaginalis to the male urethra has been confirmed so far.The Asian Association of Urinary Tract Infection and Sexually Transmitted Infection (AAUS) belonging to the Urological Association of Asia (UAA) had developed the guidelines regarding NCNGU and the present guidelines were updated from previous edition. Relevant references were meticulously reviewed again and latest studies were collected. In addition to the levels of evidence, the recommendation grades were defined using the modified GRADE methodology. Herein, we present the new edition of the UAA-AAUS guidelines for M. genitalium and non-chlamydial non-gonococcal urethritis.     

A Review of “Optimal Fallow Period” Guidance Across Canadian Jurisdictions

IntroductionUnderstanding how different countries have responded to mitigate the risk of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) transmission in dental offices is important. This article describes the different approaches taken towards optimal fallow periods in Canadian jurisdictions.MethodsWe searched publicly available information from dentist and dental hygiene regulator websites across the 10 provinces and 3 territories in Canada. We also searched for guidance documents on dental associations’ websites or through personal communication with government officials. We extracted and tabulated information on fallow period recommendations or guidance, when available.ResultsNine jurisdictions (6 provinces and all 3 territories) acknowledge or provide guidance on fallow periods following aerosol-generating procedures. Among those who have provided guidance regarding a fallow period, recommendations follow the Centers for Disease Control and Prevention guidance if the air changes per hour (ACH) in the dental operatory is known.ConclusionThe evidence for deciding on optimal fallow period is limited and still being explored, resulting in substantial variation across Canadian jurisdictions. A focus on developing scientific evidence relevant to dentistry and assimilating existing science is crucial to establishing consistency and uniformity in information to deliver safe oral health care services.     

大学生蠕形螨感染情况调查

目的:了解在校大学生蠕形螨感染情况,探讨蠕形螨感染与面部皮肤疾病的关系.方法:采用透明胶带粘贴法对638名在校大学生进行蠕形螨检查,同时对面部皮肤状况进行调查.结果:在校大学生蠕形螨感染率为17.55%,且男性(22.05%)显著高于女性(14.58%);毛囊蠕形螨面部感染率(65.18%)高于皮脂蠕形螨(24.11%);有面部皮肤疾病者蠕形螨感染率明显高于面部皮肤正常者.结论:本校大学生蠕形螨感染较为普遍,感染多为毛囊蠕形螨;蠕形螨感染是痤疮、酒渣鼻等皮肤疾病的致病因素之一.     

四川省雅安市嫖客HIV和梅毒感染状况及相关行为调查

目的 了解四川省雅安市嫖客人群HIV和梅毒感染状况及相关危险行为。方法 2014年4月至2015年12月,在雅安市开展横断面调查,滚雪球法招募708例嫖客作为调查对象,通过面对面问卷调查收集嫖客基本人口学、艾滋病有关知识和行为学等信息,抽取调查对象5 ml静脉血进行HIV和梅毒抗体检测,利用SPSS 18.0统计学软件进行数据整理和分析。结果 708名嫖客中,≥50岁年龄组人数占51.27%（363/708）;汉族占99.72%（706/708）;初中及以下文化程度占90.11%（638/708）;在婚/同居占74.15%（525/708）;每次均使用安全套占27.40%（194/708）。HIV抗体阳性7例,其中4例年龄≥50岁;检出梅毒抗体阳性病例7例,年龄均≥50岁;HIV和梅毒抗体阳性率均为0.99%（95% CI：0.30%～1.70%）;未发现HIV和梅毒合并感染病例。多因素logistic回归分析显示,首次发生商业异性性行为年龄<30岁（OR=6.61,95% CI：1.09～40.18）的嫖客其HIV抗体阳性率较高。结论 雅安市嫖客人群安全套使用率较低,自我保护意识较弱,尤其是≥50岁的嫖客文化程度较低,其经商业性行为感染HIV和梅毒的风险较高,应给予足够的重视。