5894 Melanoma is a potentially lethal cancer that responses poorly to radiotherapy and other commonly used chemotherapeutic agents. Although much attention has been focused on melanoma immunotherapy, few effective therapeutic agents for melanoma exist, especially those useful for treatment of metastatic disease. A novel low MW agent, WP1066, was synthesized that effectively blocked Stat3 activation by cytokines and induced c-myc degradation in multiple tumor cell types. Since melanoma cells express constitutively activated Stat proteins and unregulated c-myc expression the antiprolifeative effects of WP1066 against the human A375 metastatic melanoma cell line were examined in vitro and in A375 xenografts in nude mice. WP1066 induced growth inhibition and apoptosis of A375 cells with an IC50 ∼1.5 μM. WP1066 suppressed Stat3 tyrosine phosphorylation without effecting Stat3 protein levels at similar concentrations (
To describe the investigation and management of patients admitted to hospitals in China with suspected acute coronary syndromes (ACS) and to identify potential areas for improvement in practice.A multicentre prospective survey of sociodemographic characteristics, medical history, clinical features, in-hospital investigations, treatment practices and major events among patients with suspected ACS.Large urban public hospitals.Consecutive patients admitted to in-patient facilities with a diagnosis of suspected acute myocardial infarction (MI) or unstable angina pectoris.Myocardial infarction/re-infarction, heart failure, death.Between September 2004 and May 2005, data were collected prospectively from 2973 patients admitted to 51 hospitals in 18 provinces of China. An initial diagnosis of ST elevation MI, non-ST elevation MI and unstable angina was made in 43%, 11% and 46% of patients, respectively. Diagnosis was inconsistent with objective measures in up to 20% of cases. At both tertiary and non-tertiary centres, there was little evidence that clinical risk stratification was used to determine the intensity of investigation and management. The mortality rate during hospitalisation was 5% overall and similar in tertiary and non-tertiary centres, but reported in-hospital re-infarction rates (8%) and heart failure rates (16%) were substantially higher at non-tertiary centres.This study has identified a number of areas in the management of ACS patients, including diagnosis and risk stratification, which deviate from current guidelines. These findings will help inform the introduction of widely used quality improvement initiatives such as clinical pathways.
Aims: This report presents one confirmed and two suspected cases of podoconiosis in the Kabale region of southwestern Uganda. Podoconiosis has not previously been described in Uganda outside of the eastern region bordering Kenya. The aim of this case report is to increase awareness of the condition in order to enhance prevention and treatment efforts. Case Study Dwek et al.; IJTDH, 9(3): 1-7, 2015; Article no.IJTDH.17672 2 Presentation of Cases: Podoconiosis is associated with chronic barefoot exposure to red volcanic soil, with greater prevalence in high-altitude, impoverished areas of the tropics. This report describes one confirmed case and two suspected cases. Case 1 was confirmed by a negative filarial antigen detection test. Cases 2 and 3 had negative filarial smears, but antigen detection kits were not available onsite at the time. However, the altitude at which all three patients live (>1500 masl) makes filarial disease unlikely. Discussion: Podoconiosis has not been previously reported in the region, and thus may be underdiagnosed due to a low index of suspicion among clinicians. Using adequate footwear is an important component of prevention. However, limited financial resources present a significant barrier to the use of footwear. Understanding community attitudes towards causes and risk factors is also integral to effective prevention. Conclusion: Podoconiosis has a high potential for elimination, as it is preventable and treatable in the early stages with consistent use of footwear and regular foot-washing. In addition, increased awareness among physicians and clinicians of the presence of the disease in this area can lead to early detection and treatment.
BACKGROUND Wounds affect millions of people world-wide, with care being costly and difficult to deliver remotely. The ongoing COVID-19 pandemic highlights the urgent need for telehealth solutions to play a larger role as part of remote care strategies for patient monitoring and care. We describe our findings on the use of a patient-facing wound care app (Swift Patient Connect App, Swift Medical, Canada) as an innovative solution in remote wound assessment and management of a diabetic patient's wound. CASE REPORT In February 2020, a 57-year-old man with type I diabetes and peripheral arterial disease presented with osteomyelitis in the left foot at the fifth metatarsal, arising from a chronic ulcer. The wound was deep, with purulent discharge and polymicrobial growth. A 6-week course of intravenous antibiotics was administered, with slow improvement of the wound. At a follow-up appointment in June 2020, The Patient Connect app was recommended to the patient to securely share calibrated images of his wound as well to communicate with his doctor. Between June 2020 and January 2021, wound closure was accurately monitored as part of the management of this diabetic foot infection. The app was also used in the management of 2 subsequent wounds and infection episodes. CONCLUSIONS Use of the Swift Patient Connect App designed to monitor and manage wounds by a patient with diabetes and foot ulcer as part of a remote care strategy resulted in numerous benefits expressed by the patient. After initial adoption, 3 successive wounds were managed with a combination of in-person and telehealth visits complemented by the app. Incorporation of this technology as part of a novel telemedicine strategy promises to have an extensive impact on remote care delivery during the current COVID-19 pandemic and beyond.
Gonorrhoea is a sexually transmitted infection of global public health concern. We investigated whole genome sequencing (WGS) as a partner notification (PN) tool in gonorrhoea management.
Methods
Between May-November 2018, all N. gonorrhoeae isolated from patients attending Leeds Sexual Health, UK, underwent WGS. Sequences were compared with historical isolates from Leeds, 2016 onwards. Reports listing sequences within 20 single nucleotide polymorphisms (SNPs) were issued to clinicians. Patient and PN data were reviewed; numbers of traceable and untraceable partners were determined. Reports were reviewed to confirm WGS links between traceable partners and to identify possible links for untraceable partners, as determined by a transmission nomogram and epidemiological match (gender, sexual orientation, onset of symptoms, and other identifiers e.g. name). Clusters of cases within 20 SNPs were examined for patterns.
Results
Overall 380 isolates from 377 cases were successfully sequenced. Traceable partners were found in 244 cases. 147 cases had at least one traceable contact with confirmed attendance, and 122 had contacts testing positive. WGS confirmed links between traceable contacts in 82 cases. Reasons for unconfirmed links include contacts testing elsewhere and testing NAAT positive, culture negative. Untraceable contacts were reported in 157 cases; WGS provided possible links in 83, with confirmation in only six, given inherent information unavailability. Cases were grouped into 123 clusters, with eight containing >10 patients. Examination of clusters highlighted gaps in partner finding, including clusters containing heterosexual females with identical strains but no male; heterosexual males with identical strains who reported female sex worker contact; confirmed instances of partner underreporting; and 35 cases with multiple partners but no genetically related case.
Conclusion
WGS has the potential to improve gonorrhoea PN and control by identifying new links and clusters with significant gaps in partner finding, where PN can be enhanced. Its utility will improve with larger databases.
Abstract Background The coronavirus disease (COVID-19) pandemic has affected residents in long-term care facilities (LTCF) significantly. Understanding transmission dynamics in this setting is crucial to control the spread of COVID-19 in this population. Using whole genome sequencing (WGS) of SARS-CoV-2, we aimed to delineate the points of introduction and transmission pathways in a large LTCF in Quebec, Canada. Methods Between 2020-10-28 and 2021-01-09, COVID-19 cases occurred in 102 residents and 111 HCW at a 387-bed LTCF; cases were distributed in 11 units on 6 floors. As part of outbreak analysis, SARS-CoV-2 isolates underwent WGS using the Oxford Nanopore Minion and the Artic V3 protocol. Lineage attribution and sequence types (ST, within 3 mutations) were assigned based on Pangolin classification and variant analysis. Epidemiologic data including date of positive PCR test, resident room number and HCW work location were collected. Self-reported high-risk exposures were collected by HCW questionnaire via phone interview after consent. Cases and their ST, geo-temporal relations and HCW-reported exposures were examined via network plots and geography-based epidemic curves to infer points of introduction and paths of transmission. Results Of 170 isolates available from 100/102 residents and 70/111 HCW, 130 (76.4%) were successfully sequenced. Phylogenetic analysis revealed 7 separate introductions to the LTCF. Grouping of ST by units was observed, with temporal appearance of ST supporting HCW introduction in 7/11 units. Proportion of phone interview completion was low at 35% (26/70). Few HCW recalled specific high-risk exposures. Recalled exposures supported by genetic linkage revealed potential between-unit introductions from HCW-to-HCW transmission at work and outside the workplace (e.g. carpooling). On one unit, a wandering resident was identified as a likely source of transmission to other residents (Figure 1). Network plot of cases clustered by geographic unit, colour-coded by sequence type. Circles represent residents; addition signs represent healthcare workers. Blue lines represent identified high-risk exposures. Node labels represent floor and unit identifiers; 2 units per floor. Conclusion We demonstrate the complex genomic epidemiology of a multi-unit LTCF outbreak, putting into evidence the importance of a multi-faceted approach to limit transmission. This analysis highlights the utility of using WGS to uncover unsuspected transmission routes, such as HCW contact outside work, which can prompt new infection control measures. Disclosures All Authors: No reported disclosures
In the version of this Article initially published, a versioning error led to a mistake in the third paragraph of the Discussion.In the text now reading "In our dataset, the most extreme and sustained increase in SARS-CoV-2 cases associated with school opening was in the South, where school opening was associated with a weekly increase in cases ranging from 9.8 to 21.3 per 100,000 people, " the range initially reported was "7.8 to 18.9 per 100,000." The results presented in the text and figures are unaffected.
