Clinical application of live biotherapeutic products in infectious diseases

Live biotherapeutics products (LBP) are a novel range of therapeutic options in medicine. In this review, authors discuss basic composition and mechanism of action of LBP, provide a comprehensive focused overview of published in vitro and in vivo studies on efficacy of LBP for prevention and treatment of infectious diseases such as viral (HIV, COVID-19), bacterial (C.difficile infection, bacterial vaginosis, multi-drug resistant organisms) and fungal (Candida) organisms. This review should be of interest to clinicians to understand the broad application of LBP in infectious diseases world beyond recurrent C.difficile infection and to researchers on unexplored prospects of LBP and the need for further investigation in this emerging field to improve its clinical application

Osteosarcoma Tumor Thrombus: a Case Report With a Review of the Literature

Tumor thrombus arising from osteosarcoma is rare. We report the case of a 20-year-old man with proximal humerus osteosarcoma, accompanied by an extensive intravascular tumor thrombus extending into the heart. Our review of the literature found 14 previous reports on osteosarcoma with tumor thrombus. The combination of positron emission tomography and computed tomography is very useful in differentiating tumor thrombus from vascular thrombus, thereby avoiding unnecessary anticoagulation therapy. This same imaging combination can also be used to evaluate the response to treatment. Surgical resection of the tumor thrombus is highly recommended. The effect of tumor thrombus on survival is still unknown

Bezlotoxumab: an emerging monoclonal antibody therapy for prevention of recurrent Clostridium difficile infection

Bhagyashri D Navalkele,1 Teena Chopra2 1Internal Medicine and Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA; 2Internal Medicine and Infectious Diseases, Infection Prevention and Epidemiology, Detroit Medical Center, Wayne State University, Detroit, MI, USA Abstract: Clostridium difficile infection (CDI) is the most common health care-acquired infection associated with high hospital expenditures. The incidence of subsequent recurrent CDI increases with prior episodes of CDI, 15%–35% risk after primary CDI to 35%–65% risk after the first recurrent episode. Recurrent CDI is one of the most challenging and a very difficult to treat infections. Standard guidelines provide recommendations on treatment of primary CDI. However, treatment choices for recurrent CDI are limited. Recent research studies have focused on the discovery of newer alternatives for prevention of recurrent CDI targeting prime virulence factors involved in C. difficile pathogenesis. Bezlotoxumab is a human monoclonal antibody directed against C. difficile toxin B. Multiple in vitro and in vivo animal studies have demonstrated direct binding of bezlotoxumab to C. difficile toxin B preventing intestinal epithelial damage and colitis. Furthermore, this monoclonal antibody mediates early reconstitution of gut microbiota preventing risk of recurrent CDI. Randomized placebo-controlled trials showed concomitant administration of a single intravenous dose of 10 mg/kg of bezlotoxumab, in patients on standard-of-care therapy for CDI, had no substantial effect on clinical cure rates but significantly reduced the incidence of recurrent CDI (~40%). It shows efficacy against multiple strains, including the epidemic BI/NAP1/027 strain. Bezlotoxumab is a US Food and Drug administration-approved, safe and well-tolerated drug with low risk of serious adverse events and drug–drug interactions. Bezlotoxumab has emerged as a novel dynamic adjunctive therapy for prevention of recurrent CDI. Further studies on real-world experience with bezlotoxumab and its impact in reducing rates of recurrent CDI are needed. Keywords: bezlotoxumab, Clostridium difficile, monoclonal antibody, novel CDI treatment, anti-toxin B antibody, prevention of recurrent CD

Study of negative parity levels in ⁶³Cu

Low-lying negative parity levels in 63Cu were Coulomb excited with 3.25 to 4.25 MeV protons to test the weak coupling core-excitation model. A Ge(Li) detector was used to measure the gamma-ray yields. The 1412, 1547, and 1861 keV levels in 63Cu were Coulomb excited for the first time. Gamma-ray angular distributions were measured at 4.25 MeV proton energy in deducing multipole mixing ratios and spin values. The E2 and M1 reduced transition probabilities were determined for the six states. The 669.6, 962, 1327, and 1547 keV levels have properties consistent with the interpretation of coupling a 2p3/2 proton to the first 2+core state. The present results were compared with the available particle–core and particle–phonon model calculations. </jats:p

Abstract T P263: Screening Practices for Sleep-Disordered Breathing in Stroke Medical Community

Background: Frequency of sleep-disordered breathing (SDB) among stroke and TIA patients ranges from 50% to 94%, and is associated with poor neurological outcomes. Per current stroke prevention guidelines from American Stroke Association, SDB is included in the list of modifiable risk factors for stroke and TIA prevention. The goal of our study was to determine screening practices for SDB in stroke medical community. Methods: A web-based survey was conducted between 12/2013 to 7/2014 among practitioners taking care of stroke patients across United States and Europe. Results: Among 112 total responses (18%), 91 were stroke physicians (81.25%), 9 were general neurologist (8.04%), 3 were sleep medicine physicians (2.68%) and 9 were other specialty (8.04%). Majority of practitioners (72%, n= 81) do not use SDB screening questionnaires in their stroke patients. Epworth sleepiness scale is the most used among SDB questionnaires (24%), followed by Berlin sleep questionnaire (9.5%) and STOP-BANG questionnaire (7%). Only 12% of practitioners use screening questionnaires in both in-patients and out- patients, where as 20% use only in out- patients and 5% use only in acute stroke setting. Only 50% of practitioners would refer their stroke patients to a sleep medicine specialist when patients were screened positive for SDB on questionnaires. Conclusion: Despite being an independent risk factor for stroke and TIA, majority of practitioners do not screen stroke and TIA patients for SDB. Further work is needed to improve screening practices for SDB in stroke medical community. </jats:p

Hydrops Fetalis and Persistent Pulmonary Hypertension in a Neonate with Anti-E Alloimmunization

Anti-E alloimmunization is the third most common cause of neonatal hemolytic disease, typically causing mild to moderate hemolytic anemia. We report an unusual case of severe hydrops fetalis and persistent pulmonary hypertension (PPHN) in a neonate with anti-E alloimmunization. Our case emphasizes the importance of close surveillance for development of severe fetal hemolytic anemia and possible need for antenatal intervention. These neonates may also need vigilant monitoring for PPHN