Development of warfarin-induced, non-uremic calciphylaxis following recovery from COVID-19 infection with acute renal injury -- a report of a case.

Herein we report a case of an obese female presenting with calciphylaxis after a prolonged hospital course due to COVID-19, with multiple complications including now-recovered acute renal failure and deep venous thrombosis requiring treatment with warfarin. Two months after discharge, she presented with new, painful, ulcerated plaques on the thighs and was diagnosed with calciphylaxis. Throughout the COVID-19 pandemic, cutaneous manifestations of SARS-CoV-2 infection have been increasingly characterized, yet non-uremic calciphylaxis is infrequently observed. Despite its rarity, our case highlights the importance of clinician awareness of the potential association of COVID-19 as an additional trigger for calciphylaxis, especially in patients with multiple risk factors. We also urge physicians to be aware of delayed onset in the presentation of calciphylaxis after renal recovery.Briana Halle (BA, Vanderbilt University School of Medicine, Nashville, Tennessee, USA), Lisa Ishii (MD, Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA), Jeffrey P. Zwerner (MD, PhD, Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA), Eva Rawlings Parker (MD, Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA)Includes bibliographical reference

Production of a Cost-Effective, TMV-Based Rabies Vaccine through Recombinant DNA Technology

Infectious diseases remain a significant cause of human deaths, as approximately 15 million deaths were attributed to infectious diseases in 2010 (Dye, 2014). One such disease is rabies, which causes around 59,000 human deaths worldwide annually according to some estimates (Kessels et al., 2017). However, 95% of human deaths attributed to rabies occur in Asia and Africa (Singh et al., 2017). Rabies is preventable, yet it is still a major concern in developing, low-income countries that lack access to the medical care necessary to combat it (Hampson et al., 2015). Alternative techniques for low-cost vaccine production have the potential to resolve this issue. This research investigates the use of recombinant DNA techniques and plant biotechnology to produce a more cost-effective vaccine for rabies. Gene sequences from the rabies glycoprotein were inserted at the end of the coat protein portion of the Tobacco Mosaic Virus (TMV) genome. Plants were then infected with this recombinant virus, with hopes that TMV particles would assemble with proteins produced from the inserted glycoprotein sequence fused to the TMV coat protein. Results thus far suggest some of the sequences could be producing recombinant TMV particles, although issues involving successful extraction and reversion to wild type are still a challenge. Additionally, other research suggests that this is an effective method for vaccine development in general and for rabies

Immune checkpoint inhibitors in patients with pre-existing psoriasis: safety and efficacy

BackgroundImmune checkpoint inhibitors (ICIs) are approved to treat multiple cancers. Retrospective analyses demonstrate acceptable safety of ICIs in most patients with autoimmune disease, although disease exacerbation may occur. Psoriasis vulgaris is a common, immune-mediated disease, and outcomes of ICI treatment in patients with psoriasis are not well described. Thus we sought to define the safety profile and effectiveness of ICIs in patients with pre-existing psoriasis.MethodsIn this retrospective cohort study, patients from eight academic centers with pre-existing psoriasis who received ICI treatment for cancer were evaluated. Main safety outcomes were psoriasis exacerbation and immune-related adverse events (irAEs). We also assessed progression-free survival (PFS) and overall survival.ResultsOf 76 patients studied (50 (66%) male; median age 67 years; 62 (82%) with melanoma, 5 (7%) with lung cancer, 2 (3%) with head and neck cancer, and 7 (9%) with other cancers; median follow-up 25.1 months (range=0.2–99 months)), 51 (67%) received anti-PD-1 antibodies, 8 (11%) anti-CTLA-4, and 17 (22%) combination of anti-PD-1/CTLA-4. All patients had pre-existing psoriasis, most frequently plaque psoriasis (46 patients (61%)) and 15 (20%) with psoriatic arthritis. Forty-one patients (54%) had received any prior therapy for psoriasis although only two (3%) were on systemic immunosuppression at ICI initiation. With ICI treatment, 43 patients (57%) experienced a psoriasis flare of cutaneous and/or extracutaneous disease after a median of 44 days of receiving ICI. Of those who experienced a flare, 23 patients (53%) were managed with topical therapy only; 16 (21%) needed systemic therapy. Only five patients (7%) required immunotherapy discontinuation for psoriasis flare. Forty-five patients (59%) experienced other irAEs, 17 (22%) of which were grade 3/4. PFS with landmark analysis was significantly longer in patients with a psoriasis flare versus those without (39 vs 8.7 months, p=0.049).ConclusionsIn this multicenter study, ICI therapy was associated with frequent psoriasis exacerbation, although flares were manageable with standard psoriasis treatments and few required ICI discontinuation. Patients who experienced disease exacerbation performed at least as well as those who did not. Thus, pre-existing psoriasis should not prevent patients from receiving ICIs for treatment of malignancy