A critical overview of current progress for COVID-19: development of vaccines, antiviral drugs, and therapeutic antibodies.

The novel coronavirus disease (COVID-19) pandemic remains a global public health crisis, presenting a broad range of challenges. To help address some of the main problems, the scientific community has designed vaccines, diagnostic tools and therapeutics for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The rapid pace of technology development, especially with regard to vaccines, represents a stunning and historic scientific achievement. Nevertheless, many challenges remain to be overcome, such as improving vaccine and drug treatment efficacies for emergent mutant strains of SARS-CoV-2. Outbreaks of more infectious variants continue to diminish the utility of available vaccines and drugs. Thus, the effectiveness of vaccines and drugs against the most current variants is a primary consideration in the continual analyses of clinical data that supports updated regulatory decisions. The first two vaccines granted Emergency Use Authorizations (EUAs), BNT162b2 and mRNA-1273, still show more than 60% protection efficacy against the most widespread current SARS-CoV-2 variant, Omicron. This variant carries more than 30 mutations in the spike protein, which has largely abrogated the neutralizing effects of therapeutic antibodies. Fortunately, some neutralizing antibodies and antiviral COVID-19 drugs treatments have shown continued clinical benefits. In this review, we provide a framework for understanding the ongoing development efforts for different types of vaccines and therapeutics, including small molecule and antibody drugs. The ripple effects of newly emergent variants, including updates to vaccines and drug repurposing efforts, are summarized. In addition, we summarize the clinical trials supporting the development and distribution of vaccines, small molecule drugs, and therapeutic antibodies with broad-spectrum activity against SARS-CoV-2 strains.

Safety and Efficacy of Deoxycholic Acid for Reduction of Upper Inner Thigh Fat.

BACKGROUND: Deoxycholic acid is an FDA-approved injectable for treatment of excess submental fat. OBJECTIVE: Study purpose was to evaluate the safety and efficacy of deoxycholic acid for reduction of upper inner thigh fat. METHODS AND MATERIALS: Fifteen subjects received 2–4 treatment sessions of deoxycholic acid 10 mg/mL injected into upper inner thigh fat. Subjects were followed to 12 weeks after last treatment. Adverse events were monitored. Efficacy measures were changes in thigh circumference, upper inner thigh skin fold thickness, and “thigh gap;” and percent accuracy by two independent blinded physicians in identifying post-treatment photographs. Patient satisfaction was assessed with questionnaires. RESULTS: There were no serious adverse events. All patients experienced expected side effects. At 12-week follow-up, decreases in thigh circumference (average change -2.2 cm) and upper inner thigh skin fold thickness (average change -8.8 mm) were observed. Average increase in “thigh gap” was 1.6 cm. Two blinded investigators correctly identified the post-treatment photograph for 83% of patients. On Subject Self-Rating Scale (6-point scale), there was average +3.0 improvement; 86% of patients were satisfied with treatment. CONCLUSION: Deoxycholic acid injection was safe and effective for reduction of upper inner thigh fat in this Phase I study. J Drugs Dermatol. 2022;21(1):66-70. doi:10.36849/JDD.5919.

Optimizing Parameters for Smoke Evacuation.

BACKGROUND: Current literature lacks recommendations regarding the ideal organization of the smoke evacuation system to minimize inhalation of surgical smoke. OBJECTIVE: This study determines optimal parameters of the smoke evacuation system with respect to the surgical field. MATERIALS AND METHODS: This study was conducted in an outpatient surgical facility at a tertiary care center. After 30 seconds of continuous electrocautery of tissue, particulate measurements were recorded using the TSI DustTrak Aerosol Monitor 8520 (>2.5 µm particles) and the TSI P-Trak Ultrafine Particle Counter 8525 (<1 µm particles) while changing the angle and distance of the smoke evacuation system. RESULTS: Particulate matter measurements were lower when suction angle was at 45° than at 90°. For both small-sized and large-sized particles, the lowest particulate matter was recorded when the evacuator was maintained at a 45° angle, 2 to 4 inches away from the cauterizing procedure. Particulate matters dramatically increased after increasing the distance of the smoke evacuator beyond 8 inches from the procedural site. CONCLUSION: In an effort to reduce smoke inhalation, the authors recommend that smoke evacuation should be placed at a 45° suction angle, no further than 8 inches away from the surgical site, while preserving the surgeon's field of vision.

Mohs Micrographic Surgery in the Veterans Health Administration.

Veterans with skin cancer have seen improved access to Mohs micrographic surgery over the past 10 years, yet the challenges of travel distance and care coordination remain.