Anti-HER2 Super Stealth Immunoliposomes for Targeted-Chemotherapy

Liposomes play an important role in the field of drug delivery by virtue of their biocompatibility and versatility as carriers. Stealth liposomes, obtained by surface decoration with hydrophilic polyethylene glycol (PEG) molecules, represent an important turning point in liposome technology, leading to significant improvements in the pharmacokinetic profile compared to naked liposomes. Nevertheless, the generation of effective targeted liposomes-a central issue for cancer therapy-has faced several difficulties and clinical phase failures. Active targeting remains a challenge for liposomes. In this direction, a new Super Stealth Immunoliposomes (SSIL2) composed of a PEG-bi-phospholipids derivative is designed that stabilizes the polymer shielding over the liposomes. Furthermore, its counterpart, conjugated to the fragment antigen-binding of trastuzumab (Fab'TRZ -PEG-bi-phospholipids), is firmly anchored on the liposomes surface and correctly orients outward the targeting moiety. Throughout this study, the performances of SSIL2 are evaluated and compared to classic stealth liposomes and stealth immunoliposomes in vitro in a panel of cell lines and in vivo studies in zebrafish larvae and rodent models. Overall, SSIL2 shows superior in vitro and in vivo outcomes, both in terms of safety and anticancer efficacy, thus representing a step forward in targeted cancer therapy, and valuable for future development.

The impact of the COVID-19 pandemic on health service use in sub-Saharan Africa

SETTING: Six hospitals in four sub-Saharan African countries.OBJECTIVE: To examine the indirect effects of COVID-19 on health service utilisation and to explore the risk of bias in studies on prediction models.DESIGN: Monthly data were analysed using interrupted time-series modelling. We used linear mixed-effect models for the analysis of antenatal care visits, institutional deliveries, vaccinations, outpatient visits and hospital admissions, and generalised linear mixed-effect models for hospital mortality.RESULTS: During 2018–2020, the six hospitals recorded a total of 57,075 antenatal care visits, 38,706 institutional deliveries, 312,961 vaccinations, 605,925 out-patient visits and 143,915 hospital admissions. The COVID-19 period was associated with decreases in vacci-nations (− 575 vaccinations, P < 0.0001), outpatient visits (− 700 visits, P < 0.0001) and hospital admission (− 102 admission, P = 0.001); however, no statistically significant effects were found for antenatal care visits (P = 0.71) or institutional deliveries (P = 0.14). Mortality rate increased by 2% per month in the pre-COVID-19 period; however, a decreasing trend (by 2% per month) was observed during the COVID-19 period (P = 0.004). Subgroup and sensitivity analyses broadly confirmed the main findings with only minor inconsistencies. A reduction in outpatient visits was also observed in hospitals from countries with a higher Stringency Index and in urban hospitals.CONCLUSIONS: The pandemic resulted in a reduction in health service utilisation. The decreases were less than anticipated from modelling studies.

Prevalence of antibodies to phleboviruses and flaviviruses in Peja, Kosovo

In order to investigate the current and past activity of phlebovirus and flavivirus in Kosovo, a seroprevalence study among 200 blood donors was performed. Positive results were obtained for the phleboviruses TOSV and SFNV, and for a flavivirus of the Japanese Encephalitis group. No positive results for TBEV were observed.

Association between depressive mood and cigarette smoking in a large Italian sample of smokers intending to quit: implications for treatment

OBJECTIVE

The aim of the study is to assess the prevalence and degree of depression at baseline of a large cohort of smokers intending to quit.

METHODS

A cross-sectional investigation was carried out on a population of 757 smokers attending the Medical Service for Addictive Disorders, at Verona University Hospital. The degree of nicotine addiction was measured by the Fagerstrom Test of Nicotine Dependence (FTND) and current mood tested by the Self-rating Depression Scale (SDS), a commonly used and well validated instrument to assess depressive mood.

RESULTS

Two hundred and twenty-two subjects (30.3%) were depressed at baseline (SDS test score > or = 50). Bivariate analysis, using the SDs score dichotomised at the cut-off of 50 as dependent variable, shows that female gender (p=0.01) and widowhood (p<0.001) were correlated to depression. Logistic regression analysis confirms the correlation between depression and female gender (OR=2.03, IC 95%=1.42-2.88, p<0.001) and between depression and widowhood, with the greatest risk of depression among widows and widowers (OR=3.22, IC 95%=1.01-10.27, p<0.048).

CONCLUSIONS

The study showed a high degree of pre-treatment depression in smokers intending to quit. Although the association between depression and nicotine dependence has been consistently reported many times, and it is well known that depressed subjects find it more difficult to quit, most guidelines seem not to consider this connection. These findings suggest the need for baseline assessment of depression by screening all smokers seeking assistance in quitting, a priority health objective because smoking is the number one avoidable killer in developed countries.

Staphylococcus lugdunensis infective endocarditis: description of 10 cases and analysis of native valve, prosthetic valve, and pacemaker lead endocarditis clinical profiles

OBJECTIVE

To evaluate the incidence and the clinical and echocardiographic features of infective endocarditis (IE) caused by Staphylococcus lugdunensis and to identify the prognostic factors of surgery and mortality in this disease.

DESIGN

Prospective cohort study.

SETTING

Study at two centres (a tertiary care centre and a community hospital).

PATIENTS

10 patients with IE caused by S lugdunensis in 912 consecutive patients with IE between 1990 and 2003.

METHODS

Prospective study of consecutive patients carried out by the multidisciplinary team for diagnosis and treatment of IE from the study institutions. English, French, and Spanish literature was searched by computer under the terms "endocarditis" and "Staphylococcus lugdunensis" published between 1989 and December 2003.

MAIN OUTCOME MEASURES

Patient characteristics, echocardiographic findings, required surgery, and prognostic factors of mortality in left sided cases of IE.

RESULTS

10 cases of IE caused by S lugdunensis were identified at our institutions, representing 0.8% (four of 467), 1.5% (two of 135), and 7.8% (four of 51) of cases of native valve, prosthetic valve, and pacemaker lead endocarditis in the non-drug misusers. Native valve IE was present in four patients (two aortic, one mitral, and one pulmonary), prosthetic valve aortic IE in two patients, and pacemaker lead IE in the other four patients. All patients with left sided IE had serious complications (heart failure, periannular abscess formation, or shock) requiring surgery in 60% (three of five patients) of cases with an overall mortality rate of 80% (four of five patients). All patients with pacemaker IE underwent combined medical treatment and surgery, and mortality was 25% (one patient). In total 59 cases of IE caused by S lugdunensis were identified in a review of the literature. The combined analysis of these 69 cases showed that native valve IE (53 patients, 77%) is characterised by mitral valve involvement and frequent complications such as heart failure, abscess formation, and embolism. Surgery was needed in 51% of cases and mortality was 42%. Prosthetic valve endocarditis (nine of 60, 13%) predominated in the aortic position and was associated with abscess formation, required surgery, and high mortality (78%). Pacemaker lead IE (seven of 69, 10%) is associated with a better prognosis when antibiotic treatment is combined with surgery.

CONCLUSIONS

S lugdunensis IE is an uncommon cause of IE, involving mainly native left sided valves, and it is characterised by an aggressive clinical course. Mortality in left sided native valve IE is high but the prognosis has improved in recent years. Surgery has improved survival in left sided IE and, therefore, early surgery should always be considered. Prosthetic valve S lugdunensis IE carries an ominous prognosis.

Sudden death in Staphylococcus aureus-associated infective endocarditis due to perforation of a free-wall myocardial abscess

Free-wall myocardial abscess perforation with hemopericardium and sudden death is an extremely infrequent complication of infective endocarditis (IE). We describe a case of Staphylococcus aureus-associated native aortic and tricuspid valve endocarditis complicated by a septic myocardial infarction and abscess formation of embolic origin, with fatal rupture into the pericardium. To our knowledge, only 2 cases of myocardial abscess rupture have previously been reported in relation to IE.

Study of 2708 heroin-related deaths in north-eastern Italy 1985-98 to establish the main causes of death

AIMS

To ascertain the causes of deaths among a very large cohort of heroin injecting drug users (IDUs) who, from 1985 to 1998, attended 36 Public Health Authority Centres for Drug Users (PCDUs) in north-eastern Italy.

DESIGN

Retrospective analysis of data, obtained from the Annual Register of each Centre and the Municipal Registry Office of each local health district.

SETTING

Thirty-six PCDUs in north-eastern Italy and Medical Service for Addictive Disorders of the University of Verona.

PARTICIPANTS

All IDUs who had sought medical care at least once in the PCDUs during the study period.

FINDINGS

Of 2708 deaths, overdose was found to be the major cause (37%), followed by AIDS (32.5%) and road accidents (9.4%). The percentage of deaths due to AIDS increased steadily from 2.7% in 1985 to 42.2% in 1996, and then decreased to 16.9% in 1998. Deaths due to overdose remained almost constant. The average age of death per year rose from 26 in the mid eighties to 34 in 1998. The mortality rate among IDUs proved much higher compared to the general population of the same age (13-fold, 95% CI, 11.3-14.6). The proportion of all deaths attributable to regular use of illegal opiates in the 15-34 age group in the general population in 1991 was 16%. HIV prevalence was not a significant factor in suicides and deaths by overdose.

CONCLUSIONS

The mortality rate was 13 times greater than in the general population. To be female and to have dropped out of any kind of treatment proved an important risk factor for overdose. The fall in deaths from AIDS enhances the problem to prevent and treat HCV infection. Decisions in drug projects, in research and in training should be influenced by the strikingly high percentage of deaths due to drug use.

Isolated presence of antibody to hepatitis B core antigen in injection drug users: do they need to be vaccinated?

In a study of 497 injection drug users who had isolated presence of antibody to hepatitis B core antigen (anti-HBc) at the time of enrollment, 404 (81%) retained this condition after a mean of 49 months of follow-up, during which time no new hepatitis B surface antigen marker was detected. These findings support the hypothesis that patients with isolated presence of anti-HBc have strong resistance to reinfection and do not need vaccination.

Aortocardiac fistulas complicating infective endocarditis

This study sought to determine the clinical and echocardiographic features, surgical approach, and outcome of patients with infective endocarditis complicated with aortocardiac fistulas among a series of 346 consecutive cases between 1988 and 1998. Nine patients (2%) were found to have aortocardiac fistulas complicating infective endocarditis caused by highly pyogenic pathogens (4 patients had ruptured abscesses of the right sinus of Valsalva, 3 had fistulous communications from the left coronary sinus, and 1 had a fistulized abscess in the noncoronary sinus). Mortality in these patients was very high (55%), even when surgery was attempted early in the course of the disease and reconstructive procedures were implemented.

[Guidelines on drug donations are not sufficient for effective coordination: the case of Mostar in former Yugoslavia]

This article deals with the problem of restoring and repairing the supply and distribution of drugs, a vital service damaged by long-term conflicts. During the post-war situation in Bosnia the Authors have been actively involved in the implementation of the Drugs Management Programme whose principal aims were as follows: 1) rationalise the arrival and storage of new drugs; 2) utilise efficiently the stocks of drugs and medical materials at hand; 3) cope with the steady post-war decrease of humanitarian aid drug donations; 4) eliminate the large quantities of expired or inappropriate drugs. The experience stresses the need that all EU countries adopt as far as possible the strict WHO guidelines in their donations to countries in emergency situations. However a very flexible organisation should be set up immediately after the conflict in order to tackle all the problems that, no doubt, will appear in the aftermath of a war.

[The significance of the isolated anti-HBc carrier. A study of 1797 drug addicts. The Intersert Group of Scientific Collaboration]

From 1985 through 1992 the following hepatitis B markers HBsAg, anti-HBs and anti-HBc were evaluated in 1797 injecting drug users (IDUs) attending 8 Centers for drug addicts in the Veneto region (north-east Italy). Among all IDUs, 1004 (56%) proved to be positive for at least one of the above markers. In particular our aim was to study the carriers of only anti-HBc. At entry, among these 1004 IDUs, 294 (29%) showed only the anti-HBc; 141 IDUs of them have been followed for a period of time: 77% remained without any marker change and 23% showed the appearance of anti-HBs. Subsequently, other 75 IDUs became carrier only of the anti HBc, for the following reasons: loss of anti-HBs (57%) or HBsAg (15%) appearance only of anti-HBc (28%). No carrier of only anti-HBc seroconverted for HBsAg. The evaluation of our data supports the hypothesis that the carrier status of the only anti-HBc prevents from reinfection by HBV and therefore these subjects do not need vaccination.

Carbamimidothioic acid phenylmethyl ester salts and their N,N'-tetramethyl derivatives as possible antimicrobial agents

A series of carbamimidothioic acid phenylmethyl ester salts and their N,N'-tetramethyl derivatives were synthesized, many of which exert an interesting inhibiting action on Gram-positive and Gram-negative bacteria and also on fungi. This activity is noteworthy in view of the large number of strains antagonized; the (3,4,5-trichlorophenyl) methyl ester chloride of carbamimidothioic acid appeared to be the best term of the series. The possible influence on this activity of decomposition kinetics to the corresponding mercapto-derivatives was investigated and compared with that of a series of N,N'-tetramethyl derivatives of previously studied carbamimidothioic acid phenyl ester salts.

The immune response of the chicken to vaccination against Newcastle disease with live virus and killed emulsified virus in relation to the length of time between two vaccinations

Chicks with no specific antibodies were initially y vaccinated against Newcastle disease at 21 days old with the live 'La Sota' strain or beta-propiolactone-killed virus emulsified in mineral oils. After a second vaccination 15 or 21 days later with the live "La Sota' strain, the interference produced by the first vaccination on the antibody production induced by the second vaccination was investigated. It was found that the live virus vaccine used for the second immunization was affected by the antibodies induced by the first vaccination, as shown in previous work utilizing 1-day-old chicks.