3 research outputs found
Elucidating the Biological Role of Autologous Derived Platelet-Rich Plasma Gel in the Treatment of Chronic Diabetic Foot Ulcers.
MD (Res)The molecular basis for the use of synthetic growth factors (GFs) in tissue reparation has been poorly investigated. More recently, autologous derived platelet rich growth factor has gained popularity in the field of regenerative/ reparative medicine, mostly because it fits the description of an ideal naturally existing constellation of GFs. However, its efficacy remains controversial. Hence, this study is designed to further elucidate the physiological role of PRP in treating chronic diabetic foot ulcers.
Platelet -rich plasma (PRP) and Platelet -poor plasma (PPP) were prepared from blood samples taken from healthy donors and diabetic patients through the use of platelet collecting and concentrating system. The GFs released were measured through immunoassay technique. The effects of the varying concentrations of PRP/PPP in culture media was assessed through tissue culture assay (proliferation, cell migration and angiogenesis assay) on human epithelia keratinocyte, dermal fibroblast and umbilical vein endothelia cell. Furthermore, immuno-histochemistry technique was used to evaluate the differentiation, proliferation, migration and extracellular matrix alterations occurring along wound margins of patients with chronic diabetic ulcers following PRP treatment.
A significant difference was observed when the expression of platelet derived growth factor-AA, epidermal growth factor, vascular endothelia growth factor, transforming growth factor and thrombospodin-I released from PRP/PPP were compared between the two groups. There was a significant proliferative, migratory and angiogenic effect of PRP over PPP in the tissue culture assay; however this effect was most prominent with 5% PRP. Overall, hyperproliferative keratin, CD44 and β1-integrin were upregulated in diabetic ulcer keratinocytes as compared with normal foot skin. The clinical study showed that 3 of the 7 diabetic foot ulcer patients treated with PRP achieved complete wound re-epithelisation. We have been able to demonstrate through in vitro studies that PRP has a positive biological effect which mimics normal physiological tissue reparation process.Barts and the London Charity Fun
Mortality Among Adults With Cancer Undergoing Chemotherapy or Immunotherapy and Infected With COVID-19
Importance: Large cohorts of patients with active cancers and COVID-19 infection are needed to provide evidence of the association of recent cancer treatment and cancer type with COVID-19 mortality. // Objective: To evaluate whether systemic anticancer treatments (SACTs), tumor subtypes, patient demographic characteristics (age and sex), and comorbidities are associated with COVID-19 mortality. //
Design, Setting, and Participants: The UK Coronavirus Cancer Monitoring Project (UKCCMP) is a prospective cohort study conducted at 69 UK cancer hospitals among adult patients (≥18 years) with an active cancer and a clinical diagnosis of COVID-19. Patients registered from March 18 to August 1, 2020, were included in this analysis. // Exposures: SACT, tumor subtype, patient demographic characteristics (eg, age, sex, body mass index, race and ethnicity, smoking history), and comorbidities were investigated. // Main Outcomes and Measures: The primary end point was all-cause mortality within the primary hospitalization. // Results: Overall, 2515 of 2786 patients registered during the study period were included; 1464 (58%) were men; and the median (IQR) age was 72 (62-80) years. The mortality rate was 38% (966 patients). The data suggest an association between higher mortality in patients with hematological malignant neoplasms irrespective of recent SACT, particularly in those with acute leukemias or myelodysplastic syndrome (OR, 2.16; 95% CI, 1.30-3.60) and myeloma or plasmacytoma (OR, 1.53; 95% CI, 1.04-2.26). Lung cancer was also significantly associated with higher COVID-19–related mortality (OR, 1.58; 95% CI, 1.11-2.25). No association between higher mortality and receiving chemotherapy in the 4 weeks before COVID-19 diagnosis was observed after correcting for the crucial confounders of age, sex, and comorbidities. An association between lower mortality and receiving immunotherapy in the 4 weeks before COVID-19 diagnosis was observed (immunotherapy vs no cancer therapy: OR, 0.52; 95% CI, 0.31-0.86). // Conclusions and Relevance: The findings of this study of patients with active cancer suggest that recent SACT is not associated with inferior outcomes from COVID-19 infection. This has relevance for the care of patients with cancer requiring treatment, particularly in countries experiencing an increase in COVID-19 case numbers. Important differences in outcomes among patients with hematological and lung cancers were observed
COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study
Background
Patients with cancer are purported to have poor COVID-19 outcomes. However, cancer is a heterogeneous group of diseases, encompassing a spectrum of tumour subtypes. The aim of this study was to investigate COVID-19 risk according to tumour subtype and patient demographics in patients with cancer in the UK.
Methods
We compared adult patients with cancer enrolled in the UK Coronavirus Cancer Monitoring Project (UKCCMP) cohort between March 18 and May 8, 2020, with a parallel non-COVID-19 UK cancer control population from the UK Office for National Statistics (2017 data). The primary outcome of the study was the effect of primary tumour subtype, age, and sex and on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prevalence and the case–fatality rate during hospital admission. We analysed the effect of tumour subtype and patient demographics (age and sex) on prevalence and mortality from COVID-19 using univariable and multivariable models.
Findings
319 (30·6%) of 1044 patients in the UKCCMP cohort died, 295 (92·5%) of whom had a cause of death recorded as due to COVID-19. The all-cause case–fatality rate in patients with cancer after SARS-CoV-2 infection was significantly associated with increasing age, rising from 0·10 in patients aged 40–49 years to 0·48 in those aged 80 years and older. Patients with haematological malignancies (leukaemia, lymphoma, and myeloma) had a more severe COVID-19 trajectory compared with patients with solid organ tumours (odds ratio [OR] 1·57, 95% CI 1·15–2·15; p<0·0043). Compared with the rest of the UKCCMP cohort, patients with leukaemia showed a significantly increased case–fatality rate (2·25, 1·13–4·57; p=0·023). After correction for age and sex, patients with haematological malignancies who had recent chemotherapy had an increased risk of death during COVID-19-associated hospital admission (OR 2·09, 95% CI 1·09–4·08; p=0·028).
Interpretation
Patients with cancer with different tumour types have differing susceptibility to SARS-CoV-2 infection and COVID-19 phenotypes. We generated individualised risk tables for patients with cancer, considering age, sex, and tumour subtype. Our results could be useful to assist physicians in informed risk–benefit discussions to explain COVID-19 risk and enable an evidenced-based approach to national social isolation policies