ZBP1-dependent inflammatory cell death, PANoptosis, and cytokine storm disrupt IFN therapeutic efficacy during coronavirus infection

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), continues to cause substantial morbidity and mortality in the ongoing global pandemic. Understanding the fundamental mechanisms that govern innate immune and inflammatory responses during SARS-CoV-2 infection is critical for developing effective therapeutic strategies. Whereas interferon (IFN)-based therapies are generally expected to be beneficial during viral infection, clinical trials in COVID-19 have shown limited efficacy and potential detrimental effects of IFN treatment during SARS-CoV-2 infection. However, the underlying mechanisms responsible for this failure remain unknown. In this study, we found that IFN induced Z-DNA-binding protein 1 (ZBP1)-mediated inflammatory cell death, PANoptosis, in human and murine macrophages and in the lungs of mice infected with β-coronaviruses, including SARS-CoV-2 and mouse hepatitis virus (MHV). In patients with COVID-19, expression of the innate immune sensor ZBP1 was increased in immune cells from those who succumbed to the disease compared with those who recovered, further suggesting a link between ZBP1 and pathology. In mice, IFN-β treatment after β-coronavirus infection increased lethality, and genetic deletion of Zbp1 or its Zα domain suppressed cell death and protected the mice from IFN-mediated lethality during β-coronavirus infection. Overall, our results identify that ZBP1 induced during coronavirus infection limits the efficacy of IFN therapy by driving inflammatory cell death and lethality. Therefore, inhibiting ZBP1 activity may improve the efficacy of IFN therapy, paving the way for the development of new and critically needed therapeutics for COVID-19 as well as other infections and inflammatory conditions where IFN-mediated cell death and pathology occur.

Ear Keloids Treated with Postoperative Electrons: A Case Series

Introduction Multiple modalities exist for treating keloids ranging from surgical, medical, chemotherapeutic, and radiation therapy. Different techniques of radiation therapy have been used to treat keloids as an adjuvant to surgical excision. With this case series, we report our experience of using electron beam radiation therapy in this setting.

Materials and Methods We retrospectively analyzed 16 ear keloids treated in 10 patients from January 2013 to October 2015 with surgical excision followed by electron beam to a dose of 10 Gy in two fractions over two consecutive days in immediate postoperative period. Patients were evaluated for recurrent lesions, cosmesis, and adverse effects.

Results With a median follow-up of 78 months (range: 67–100 months), recurrent lesion was seen in five cases; a local control rate of 68.75% was seen. Median recurrence-free period was 67 months (range: 12–100 months). Acceptable cosmesis was seen in all cases and no acute or chronic adverse effects were seen.

Conclusion The large follow-up period in our series establishes the role of electron beam radiation therapy in attaining long-term control in keloid patients. The lower total dose with higher dose per fraction used in our patients has acceptable control along with good cosmesis and absent adverse effects.

A multicenter study on the utility and safety of EBUS-TBNA and EUS-B-FNA in children

BACKGROUND AND AIM

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound with an echobronchoscope-guided fine needle aspiration (EUS-B-FNA) are useful modalities in the evaluation of mediastinal lymphadenopathy in adults; however, there is sparse data in children. The aim of this multicenter study is to describe the efficacy and safety of EBUS-TBNA and EUS-B-FNA in children with mediastinal lymphadenopathy of undefined etiology.

METHODS

Retrospective analysis of consecutive pediatric (<18 years) subjects who underwent EBUS-TBNA or EUS-B-FNA for the evaluation of mediastinal lymphadenopathy. The demographic characteristics, indications, procedural details, pathological, cytological and microbiological diagnosis, diagnostic yield, and complications are presented.

RESULTS

Of the 3,424 EBUS/EUS-B-FNA procedures, 67 (1.9%) were performed in the pediatric (3-17 years) population. Of these, 19 (28.4%) were performed in children ≤12 years of age. Overall, EBUS-TBNA and EUS-B-FNA were performed in 53 and 12 subjects, respectively. In two subjects, no significant lymph node was seen on EBUS. The procedure was performed under moderate sedation in spontaneously breathing subjects in 54 (80.6%) instances. An adequate sample was obtained in 60 (92.3%) subjects while a diagnostic sample was obtained in 37 (56.9%) of the 65 subjects. The diagnostic yield was not significantly different (P = 0.59) between EBUS-TBNA (58.5%) and EUS-B-FNA (50%). The sensitivity of EBUS-TBNA/EUS-B-FNA was 79.1% and led to a change in diagnosis in 28 (41.8%) subjects. Complications, all minor were encountered in six (8.9%) subjects.

CONCLUSIONS

EBUS-TBNA and EUS-B-FNA are safe techniques with a good diagnostic yield in the evaluation of children with mediastinal lymphadenopathy. Pediatr Pulmonol. 2016;51:1031-1039. © 2016 Wiley Periodicals, Inc.

Clinical experience on use of oral EGFR-TKIs as first-line treatment of advanced NSCLC from a tertiary care centre in North India and implications of skin rash

BACKGROUND

Limited data are available from India on treatment outcomes with oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in newly diagnosed non-small cell lung cancer (NSCLC). We studied the demographic profile and treatment outcomes of patients with NSCLC, receiving first-line treatment with oral EGFR-TKIs.

METHODS

Retrospective study of newly diagnosed NSCLC patients treated with oral EGFR-TKIs over a 4-year period at a tertiary care institute in North India.

RESULTS

Of 76 patients studied, females and non-smokers constituted 32.9% and 48.7%, respectively. Majority of patients had adenocarcinoma (59.2%), stage IV (64.5%) disease and Karnofsky performance status ≤ 70 (74.5%). Gefitinib was the most frequently used EGFR-TKI (92.1%). Most common indication for the use of EGFR-TKIs was poor performance status (65.8%). Among assessable patients, disease control and progressive disease were evident in 66% and 34%, respectively. Most common side effects were skin rash (17%) and diarrhoea (10.6%). Patients with and without skin rash differed significantly in relation to objective response to treatment (100% versus 23.1%) and overall survival (median not reached versus 178 days). On multivariate logistic regression analysis, malignant pleural effusion was associated with occurrence of rash (odds ratio = 0.19; 95% confidence interval = 0.04-0.95; p = 0.04).

CONCLUSIONS

Oral EGFR-TKIs appear to be useful for the treatment of clinically selected patients with advanced NSCLC. Occurrence of skin rash was independently associated with treatment response and better survival in the current study.

Speciation of coagulase negative Staphylococcal isolates from clinically significant specimens and their antibiogram

BACKGROUND

Despite their frequency as contaminants, coagulase-negative Staphylococci (CONS) have become important nosocomial pathogens, accounting for 9% of all nosocomial infections. These infections are difficult to treat because of the risk factors and the multiple drug resistance nature of these organisms.

MATERIALS AND METHODS

One hundred and two consecutive CONS were isolated from various clinical samples like blood, pus, urine, urine catheter tip and gastric lavage. Most of the blood samples were from patients with risk factors (immunocompromised or on medical devices). After confirming the isolates as CONS, species-level identification was performed by simple, non-expensive conventional methods and antibiotic sensitivity testing was also carried out.

RESULTS

Of 102 CONS isolates, 100 isolates could be identified to the species level. Among the 100 isolates, epidermidis was the most common species isolated, seen in 32%, followed by S. hemolyticus (18%), S. lugdunensis (12%), S. hominis (10%), S. saprophyticus (8%), S. capitis (6%), S. caprae (4%), S. xylosus (4%), S. cohni and S. warneri (3% each). In the present study, 56% of the isolates were methicillin-resistant CONS. Most of the isolates showed resistance to ampicillin and amoxyclav (89% each), followed by ceftriaxone (52%), cotrimoxazole (46%), cefotaxime (32%), gentamicin (25%), amikacin (21%).

CONCLUSION

The increased pathogenic potential and multiple-drug resistance demonstrates the need to adopt simple, reliable and non-expensive methods for identifying and determining the antibiotic sensitivity of CONS.

Study of deflections in maxillary major connectors: a finite element analysis

The Major connector is the major component of the cast partial denture to which all other parts are directly or indirectly attached. It also provides cross arch stability to help resist displacement by functional stresses. The major connector should be rigid. A flexible major connector causes an unequal distribution of forces with changes in their intensity and may cause damage to the supporting structures. Thus rigidity is of paramount to resist flexing and torquing forces. The commonly used major connectors for the maxillary arch are Anteroposterior strap, palatal strap and complete palatal plate. Application of load on the prosthesis will result in deflection. The magnitude and direction of the deflection that the prosthesis undergoes depends on the rigidity of the major connector. (1) To determine the deflection seen in maxillary removable partial denture frameworks under simulated occlusal load. (2) To compare the rigidity and deflection characteristics of different maxillary major connectors used in maxillary Kennedy's class I, class II, class III and class IV situations. A CT scan of human edentulous maxilla was taken and each section from the incisive foramen to the hamular notch was projected on the graph paper and three dimensional volumes were created from the connected successive profiles to define the final solid geometry of bone. Six framework models with different Maxillary major connectors such as Anteroposterior straps and complete palatal plate for Kennedy's class I, class II, class III and class IV situations were created. Three Dimensional Finite Element Models corresponding to the geometric model were created using ANSYS 9.0 version. The model was assigned the material properties. A vertical biting force of 20 N was applied. The results showed maximum displacements were observed at the posterior edge of the saddle for all the frameworks. Anteroposterior palatal strap in class III and class IV situation showed the least deflection when compared to class I and class II (distal extension situation) Anteroposterior palatal strap is more rigid connector than the full palatal plate, single palatal strap, and U-shaped palatal strap and can be used in all situations.

In-flight spontaneous pneumothorax: congenital cystic adenomatoid malformation of the lung

Congenital cystic adenomatoid malformation (CCAM) is a rare congenital abnormality. Symptomatic presentation in adult life is extremely uncommon. The usual radiological appearance of CCAM is a cystic space-occupying lesion. Patients with underlying cystic lung disease can develop in-flight complications because of pressure-volume changes during ascent. We report the first ever case in which spontaneous pneumothorax during flight was the presenting manifestation of CCAM of the lung in a previously healthy and asymptomatic young adult. We also discuss the physiological changes during air travel which contribute to the pathogenesis of respiratory complications during air travel.

Seroprevalence of Chlamydia trachomatis infection in women with bad obstetric history and infertility

Chlamydia trachomatis has currently emerged as the most common sexually transmitted pathogen. It is usually asymptomatic and is difficult to diagnose clinically. It is one of the causes for bad Obstetric History (BOH) and infertility. Women at highest risk often have the least access to health care facilities. Therefore there is a need for a rapid, simple, inexpensive and non-invasive test to detect C. trachomatis infection. Serological testing forms the mainstay of diagnosing the disease and to treat BOH and infertility. Hence the present study was conducted. Enzyme linked immunosorbent Assay (ELISA) was used for detection of IgG antibodies against C. trachomatis. Out of 260 cases, 130 had history of BOH, 80 had history of infertility and 50 healthy pregnant women (HPW) were used as controls. The seropositivity of C. trachomatis in the study was 25.4% (66). Out of 130 cases of BOH, seropositivity was 27.7% (36). Out of 80 cases of infertility, seropositivity was 35% (28) and out of 50 cases of HPW seropositivity was 4% (2). In BOH cases, women with history of two abortions showed seropositivity of 7.3% and women with history of three or more abortions showed seropositivity of 62.5%. Hence, seropositivity of C. trachomatis infection was found to be significant among women with BOH and infertility as compared to HPW.

Hyperbaric oxygen therapy in free flap surgery: is it meaningful?

BACKGROUND

Hyperbaric oxygen therapy is a recognised modality of treatment with applications in plastic surgery. This modality of treatment works by providing higher oxygen delivery to tissues. The benefits of this modality of treatment in free flap surgery were studied.

METHOD

A randomised prospective study was done. Ten patients undergoing free tissue transfer by microvascular technique were studied. These patients were randomised into two groups. In Group 1 the patients were subjected to hyperbaric oxygen therapy postoperatively for seven days. Group 2 served as the control group. Patients in this group were not subjected to hyperbaric oxygen therapy. Patients were evaluated up to 14 days postoperatively. The flaps were evaluated for any flap loss, presence of venous congestion in the flap, flap oedema, and completeness of healing at the flap site.

RESULTS

No significant difference was found in terms of flap survival, time to resolution of venous congestion, resolution of oedema, and period of postoperative recovery.

CONCLUSION

Routine use of hyperbaric oxygen therapy does not result in better survival of free flaps.