T‐cell responses and therapies against SARS‐CoV‐2 infection

Coronavirus disease 2019 (COVID‐19) is caused by SARS‐CoV‐2, a novel coronavirus strain. Some studies suggest that COVID‐19 could be an immune‐related disease, and failure of effective immune responses in initial stages of viral infection could contribute to systemic inflammation and tissue damage, leading to worse disease outcomes. T cells can act as a double‐edge sword with both pro‐ and anti‐roles in the progression of COVID‐19. Thus, better understanding of their roles in immune responses to SARS‐CoV‐2 infection is crucial. T cells primarily react to the spike protein on the coronavirus to initiate antiviral immunity; however, T‐cell responses can be suboptimal, impaired or excessive in severe COVID‐19 patients. This review focuses on the multifaceted roles of T cells in COVID‐19 pathogenesis and rationalizes their significance in eliciting appropriate antiviral immune responses in COVID‐19 patients and unexposed individuals. In addition, we summarize the potential therapeutic approaches related to T cells to treat COVID‐19 patients. These include adoptive T‐cell therapies, vaccines activating T‐cell responses, recombinant cytokines, Th1 activators and Th17 blockers, and potential utilization of immune checkpoint inhibitors alone or in combination with anti‐inflammatory drugs to improve antiviral T‐cell responses against SARS‐CoV‐2.     

The long-term consequence of salivary contamination at various stages of adhesive application and clinically feasible remedies to decontaminate

Clinical Oral Investigations - To analyse the bond quality in dentine post-ageing after salivary contamination and decontamination at different stages of dental adhesive application. A total of...     

Recurrent hyperhemolytic transfusion reaction in myelodysplastic syndrome- A case based approach

We present here a case report of a 27 year old female, with myelodysplatic syndrome suspected to have recurrent hyperhemolytic transfusion reactions (HHTR). Patient was transfusion dependent for ten years and was transfused with leukodepleted and irradiated Packed Red Blood Cells (PRBC). She presented with signs and symptoms of acute intravascular hemolysis, deranged coagulation profile with post transfusion Hb lower than baseline. Post transfusion workup was uneventful. She was managed conservatively with fluid support and methylprednisolone initially. After few uneventful transfusions, patient developed second episode of HHTR with compatible unit.Immunophenotype favored an inflammatory response possibly induced by monocytic lineage. As transfusion dependent, the patient required methylprednisolone as premedication and all subsequent transfusions were uneventful.     

Defects in Mitochondrial Efficiency and H2O2 Emissions in Obese Women Are Restored to a Lean Phenotype With Aerobic Exercise Training

The notion that mitochondria contribute to obesity-induced insulin resistance is highly debated. Therefore, we determined whether obese (BMI 33 kg/m²), insulin-resistant women with polycystic ovary syndrome had aberrant skeletal muscle mitochondrial physiology compared with lean, insulin-sensitive women (BMI 23 kg/m²). Maximal whole-body and mitochondrial oxygen consumption were not different between obese and lean women. However, obese women exhibited lower mitochondrial coupling and phosphorylation efficiency and elevated mitochondrial H₂O₂ (mtH₂O₂) emissions compared with lean women. We further evaluated the impact of 12 weeks of aerobic exercise on obesity-related impairments in insulin sensitivity and mitochondrial energetics in the fasted state and after a high-fat mixed meal. Exercise training reversed obesity-related mitochondrial derangements as evidenced by enhanced mitochondrial bioenergetics efficiency and decreased mtH₂O₂ production. A concomitant increase in catalase antioxidant activity and decreased DNA oxidative damage indicate improved cellular redox status and a potential mechanism contributing to improved insulin sensitivity. mtH₂O₂ emissions were refractory to a high-fat meal at baseline, but after exercise, mtH₂O₂ emissions increased after the meal, which resembles previous findings in lean individuals. We demonstrate that obese women exhibit impaired mitochondrial bioenergetics in the form of decreased efficiency and impaired mtH₂O₂ emissions, while exercise effectively restores mitochondrial physiology toward that of lean, insulin-sensitive individuals.     

Risk factors for genital chlamydial infection.

OBJECTIVE: To discuss the occurrence of genital chlamydia in developed countries and review the literature assessing the potential risk factors for this sexually transmitted disease. DATA SOURCES: A MEDLINE search was performed for all English citations from 1985 to 2000 that contain the keywords "Chlamydia trachomatis", "chlamydial infections", "risk factors" and "sex behaviour". All relevant references cited in articles that were obtained from the search were also included. DATA EXTRACTION: ALL ARTICLES OBTAINED FROM THE ABOVE SOURCES WERE EXAMINED, AND WERE INCLUDED IN THE REVIEW IF THEY MET THE FOLLOWING CRITERIA: primary study examining sociodemographic or behavioural risk factors associated with genital chlamydial infection using multivariate analysis; study subjects 12 years of age and older; and study setting in a developed country. DATA SYNTHESIS AND CONCLUSIONS: Genital chlamydial infection has become the most commonly reported bacterial infection in North America over the past decade. Thirty-eight cross-sectional studies and six cohort studies were included in the present review. Most studies demonstrated that young men and women are at higher risk of being infected with chlamydia than older subjects. Chlamydia seems to be found in a diverse group of people, and unlike gonorrhea, is not concentrated in low income, minority core groups with high rates of partner change. However, a number of studies have shown that communities with well-established control programs are beginning to demonstrate this pattern. There is no clear evidence that chlamydia is associated with type of partners, contraceptive use, or age at first intercourse. Future research should follow this sexually transmitted disease as it evolves through the epidemiological stages to ensure that preventive and treatment services are reaching those people who are most likely to be infected.     

NORMATIVE VALUES FOR THE FUNCTIONAL MOVEMENT SCREENTM IN ADOLESCENT SCHOOL AGED CHILDREN

Background

International sports programs have established pre‐participation athletic screening procedures as an essential component to identify athletes that are at a high risk of becoming injured. The Functional Movement Screen (FMS™) is a screening instrument intended to evaluate deficiencies in the mobility and stability of an athlete that might be linked to injury. To date, there are no published normative values for the FMS™ in adolescent school aged children. The purpose of this study was to establish normative values for the FMS™ in adolescent school aged children (10 to 17 years). Secondary aims were to investigate whether the performance differed between boys and girls and between those with or without previous history of injury.

Methods

1005 adolescent school students, including both males and females between the ages of 10 and 17 years who fulfilled the inclusion and exclusion criteria, were selected for the study. The test administration procedures, instructions and scoring process associated with the standardized version of the test were followed in order to ensure accuracy in scoring. The components of the FMS™ include the deep squat, hurdle step, in‐line lunge, shoulder mobility, active straight leg raise, trunk stability push up, and rotary stability.

Results

The mean composite FMS™ score was 14.59 (CI 14.43 ‐ 14.74) out of a possible total of 21. There was a statistically significant difference in scores between females and males (p= .000). But no statistically significant difference in scores existed between those who reported a previous injury and those who did not report previous injury (p=.300). The variables like age (r= ‐.038, p=.225), height(r= .065, p= .040), weight (r=.103, p=.001) did not show a strong correlations with the mean composite score.

Conclusion

This study provides normative values for the FMS™ in adolescent school aged children, which could assist in evaluation of functional mobility and stability in this population.

Level of evidence

2c     

Patient and Provider Attitudes Toward the Use of Patient Portals for the Management of Chronic Disease: A Systematic Review

Background

Patient portals provide patients with the tools to better manage and understand their health status. However, widespread adoption of patient portals faces resistance from patients and providers for a number of reasons, and there is limited evidence evaluating the characteristics of patient portals that received positive remarks from patients and providers.

Objective

The objectives of this systematic review are to identify the shared characteristics of portals that receive favorable responses from patients and providers and to identify the elements that patients and providers believe need improvement.

Methods

The authors conducted a systematic search of the CINAHL and PubMed databases to gather data about the use of patient portals in the management of chronic disease. Two reviewers analyzed the articles collected in the search process in order remove irrelevant articles. The authors selected 27 articles to use in the literature review.

Results

Results of this systematic review conclude that patient portals show significant improvements in patient self-management of chronic disease and improve the quality of care provided by providers. The most prevalent positive attribute was patient-provider communication, which appeared in 10 of 27 articles (37%). This was noted by both patients and providers. The most prevalent negative perceptions are security (concerns) and user-friendliness, both of which occurred in 11 of 27 articles (41%). The user-friendliness quality was a concern for patients and providers who are not familiar with advanced technology and therefore find it difficult to navigate the patient portal. The high cost of installation and maintenance of a portal system, not surprisingly, deters some providers from implementing such technology into their practice, but this was only mentioned in 3 of the 27 articles (11%). It is possible that the incentives for meaningful use assuage the barrier of cost.

Conclusions

This systematic review revealed mixed attitudes from patients and their providers regarding the use of patient portals to manage their chronic disease. The authors suggest that a standard patient portal design providing patients with the resources to understand and manage their chronic conditions will promote the adoption of patient portals in health care organizations.     

Fulminant onset of acute leukemia from normal hematopoiesis within 3 months of follow up for multiple myeloma treated with total therapy protocols

Assiduous surveillance for genetic aberrations is necessary in patients on cytotoxic therapies to detect therapy‐related myeloid neoplasms (t‐MN). Current modalities include metaphase cytogenetics and FISH. Since t‐MN may develop abruptly in cytogenetically normal patients, a discussion exploring additional methods such as SNP‐array and targeted‐deep‐sequencing to detect subchromosomal abnormalities is needed.     

COPD-related Bronchiectasis; Independent Impact on Disease Course and Outcomes

Background: COPD and radiographic bronchiectasis frequently coexist but the effect of this on the clinical course of COPD is not fully understood. We determined the impact of bronchiectasis on clinical outcomes in COPD patients, independent of coexisting emphysema and bronchial wall thickening (BWT). Methods: COPD patients admitted with first exacerbation 1998–2008 were identified retrospectively using ICD10 codes J44.0,1,8,9. Patients with suitable CT scans were graded for severity of bronchiectasis, emphysema and BWT on a 5 point scale (0-absent, 1-minor, 2-mild, 3-moderate, 4-severe). Results: 406 patients (71 ± 11 years, 56% male, FEV₁ 52 ± 23% predicted) were included; 278 (69%) patients had bronchiectasis: minor, 112 (40%); mild, 81 (29%); moderate, 62 (22%); severe 23 (8%). Bronchiectasis severity correlated with severity of BWT (p < 0.001) but not emphysema (p = 0.090). Bronchiectasis independently determined sputum isolation of Pseudomonas aeruginosa (Odds ratio (OR) 1.39 (95% CI 1.07 to 1.80), p = 0.013) and atypical mycobacteria (OR 2.44 (95% CI 1.04 to 5.69), p = 0.040), annual respiratory admissions (p = 0.044) and inpatient days (p < 0.001), but did not predict survival (p = 0.256). Conclusions: Radiographic bronchiectasis in COPD patients is associated with increased respiratory infection and hospitalisation, independent of coexisting emphysema and BWT. COPD-related bronchiectasis is therefore an important diagnosis with potential implications for treatment.