Editing the Human Genome with CRISPR/Cas: A Review of its Molecular Basis, Current Clinical Applications, and Bioethical Implications

ABSTRACT CRISPR/Cas genes evolved in prokaryotic organisms as a mechanism of defense designed to identify and destroy genetic material from threatening viruses. A breakthrough discovery is that CRISPR/Cas system can be used in eukaryotic cells to edit almost any desired gene. This comprehensive review addresses the most relevant work in the CRISPR/Cas field, including its history, molecular biology, gene editing capability, ongoing clinical trials, and bioethics. Although the science involved is complex, we intended to describe it in a concise manner that could be of interest to diverse readers, including anyone dedicated to the treatment of patients who could potentially benefit from gene editing, molecular biologists, and bioethicists. CRISPR/Cas has the potential to correct inherited diseases caused by single point mutations, to knock-in the promoter of a gene whose expression is highly desirable or knockout the gene coding for a deleterious protein. CRISPR/Cas technique can also be used to edit ex vivo immune cells and reinsert them in patients, improving their efficiency in attacking malignant cells, limiting the infectious potential of viruses or modulating xenotransplant rejection. Very important bioethical considerations on this topic include the need to internationally regulate its use by ad hoc expert committees and to limit its use until safety and bioethical issues are satisfactorily resolved.

A prospective descriptive study on emergency medicines used most frequently from the emergency medicine packs at Universitas Academic Hospital and the associated financial loss of expired emergency medicines

Resuscitation trolleys with equipment and medicines for emergencies are required in all clinical areas in hospitals. Emergency medicines kept separately are more likely to expire than non-emergency medicines, as these are generally used less frequently. An updated list of essential emergency medicines was implemented in 2016 at an academic hospital in central South Africa. The aim of this study was to determine the frequency of both the use and the expiry, with associated financial losses, of the emergency medicines on this list. Methods: A prospective, descriptive study was conducted over a six-month period in 2019. Forms accompanying the emergency packs were returned to the pharmacy whenever packs expired or were opened. These forms were collected and the type and quantity of medicines either used or expired were recorded. Results: In total, 168 of the returned forms were included. The most frequently used emergency medicines were adrenaline, sodium bicarbonate and Ringer's lactate. Adrenaline use was recorded on 52.8% and 25% of the forms from the adult/paediatric and neonatal emergency packs, respectively. Medicines that were never used included: betamethasone, Darrow's half-strength solution and most of the neonatal pack medications. Neonatal emergency medicine packs were rarely used and the neonatal fluid packs were never used. The total cost of the expired medicines was R7 960.29 (US$569.41 at the time of the study). Adrenaline was the medication that expired most frequently but the greatest financial losses occurred from expired sodium bicarbonate. Conclusion: The total financial losses were low but can be reduced further. The contents of the emergency packs should be reviewed to possibly reduce the amount of items used infrequently. Also, the removal of those items not recommended in emergency care guidelines could be considered. Ensuring the policy was followed of returning unused medicines close to expiry and redistributing these to high-use areas would further reduce wastage

Effectiveness of Teaching Standardized Protocol on Safe Medication Administration Process Upon the Level of Knowledge among Nurses at a Tertiary Care Hospital, Chennai

Strategies to improve medication safety focused on acute care settings. Twenty-six studies and descriptions of quality improvement projects were identified. Strategies used to focus on recommendations to prevent medication errors at various stages, from a nationwide voluntary organization to improve safety of patients and empower education system of nurses and other health care providers in safe practices in health care system and vast growing technology.

Skin as an endocrine organ: A narrative review

Skin being the largest organ of the body, is equipped with numerous functional properties. Over the past few years, intricate research into the biology of skin has led to a gamut of discoveries. Skin is now regarded as one of the most vital endocrine organs. The skin contains equivalents of the hypothalamo-pituitary-adrenal axis, hypothalamo-pituitary-thyroid axis and the appendages produce multiple hormones such as Vitamin D, sex steroids, retinoids and opioids. In this article, we will explore the role of skin as a target and source of some of the hormones of the human body, and briefly touch on the clinical applications

Micro- and macro-level economic implications of digital addictions: A case study

Introduction: Technology has significantly transformed how we live our lives. The Internet has made life easier by making knowledge more accessible to all and connecting individuals all over the world. However, it has also caused many people to spend far too much time in front of the computer, to the point that it has become the center of their existence. Materials and Methods: A case of a 20-year-old male student of Bachelor of Engineering, who belongs to the middle socio-economic status of a rural area, is digitally addicted, and getting treated in a tertiary hospital in Karnataka, India. Discussion and conclusion: Digital addiction can cause various psychological issues, particularly anxiety, depression, insomnia, and behavioral issues. It further creates an economic crisis in the family of a digital addict as well as for the nation. Therefore, to address the implications of digital addiction, the country must devote resources towards awareness, prevention, and intervention in the area of digital addiction.

Registro Nacional Argentino de Resonancia Cardíaca (RENAREC) / Argentine National Cardiac Magnetic Resonance Imaging Registry (RENAREC)

RESUMEN Introducción: La utilidad de la resonancia magnética cardíaca (RMC) ha crecido ampliamente en los últimos años, en los cuales se han publicado distintos registros internacionales sobre su uso e impacto clínico. Sin embargo, no contamos con este tipo de información en Argentina. Objetivo: Evaluar indicaciones, protocolos utilizados, seguridad y consecuencias terapéuticas de la RMC en la República Argentina. Material y métodos: Se diseñó un registro prospectivo a nivel nacional con recolección de datos demográficos, indicaciones de RMC, complicaciones asociadas, diagnósticos y consecuencias terapéuticas. Resultados: Participaron 34 centros de 10 provincias de Argentina (85% centros privados, 59% centros con internación). Se incluyeron 1131 pacientes (edad 54 ± 18 años, 61% varones). Las principales indicaciones para el estudio de RMC fueron la miocardiopatía hipertrófica (13,9%) y la arritmia ventricular (12,3%). El 99,7% de los estudios fueron reportados sin complicaciones. Los resultados más frecuentes de la RMC fueron: normal (31,2%), miocardiopatía no isquémica (14,7%), miocardiopatía isquémico-necrótica (11,6%) y miocardiopatía hipertrófica (8,9%). La sospecha clínica fue confirmada en el 23,6% de los casos y la RMC generó un diagnóstico nuevo no sospechado en el 48,7% de los casos. Las consecuencias terapéuticas más frecuentes fueron el alta hospitalaria (31,6%) seguida por el cambio en la medicación (28,1%). Conclusiones: La RMC es un estudio ampliamente utilizado en Argentina, principalmente en centros privados, con un número muy bajo de complicaciones. Las principales indicaciones son las miocardiopatías (hipertrófica y dilatada) y la arritmia ventricular, y provee un diagnóstico nuevo no sospechado en casi la mitad de los casos. Se requieren de otros estudios en el futuro para evaluar las implicancias clínicas y terapéuticas.

ABSTRACT Background: The usefulness of cardiac magnetic resonance imaging (MRI) has greatly increased in the last years. Different international registries have been published on its use; however, there is no data available from Argentina. Objective: The aim of this study was to evaluate different indications, protocols, safety and therapeutic consequences of cardiac MRI in Argentina. Methods: A prospective national registry was designed with collection of demographic data, indications for cardiac MRI, associated complications, diagnoses and therapeutic consequences. Results: A total of 34 centers from 10 provinces of Argentina (85% private and 59% with inpatient capacity) participated in the study, including 1131 patients (mean age 54±18 years and 61% males). The main indications for cardiac MRI were hypertrophic cardiomyopathy (13.9%), and ventricular arrhythmia (12.3%). In 99.7% of cases, no study complications were reported. The most frequent results of cardiac MRI were: normal (31.2%), non-ischemic cardiomyopathy (14.7%), ischemic-necrotic cardiomyopathy (11.6%) and hypertrophic cardiomyopathy (8.9%). Clinical suspicion was confirmed in 23.6% of cases and cardiac MRI generated an unsuspected new diagnosis in 48.7% of cases. The main therapeutic consequences were hospital discharge (31.6%) followed by change in medication (28.1%). Conclusions: Cardiac MRI is widely used in Argentina, mainly in private centers with a very low incidence of complications. Cardiomyopathies (hypertrophic and dilated) and ventricular arrhythmia are its main indication, and it provides a new unsuspected diagnosis in almost half of the cases. Further studies are required to assess its clinical and therapeutic impact.

Mental Boost up: Is It Life-Changing for Cancer?

Background: Though human civilization has reached its 21st-century cancer is still considered as the name of a fatal alarm all over the world. More or less, all cancer patients start being haunted by the horror of death from the day of diagnosis. This fear not only weakens their physical and psychological stature; it also has a bad impact on their normal lifestyles. Even this apprehension also affects their treatment as well. However, it is believed that the mind is the driving force of a man, that is, nothing intimidating can happen to a man who possesses a strong mind. Aim of the study: the purpose of this study is to see whether boosting, increasing, or instilling mental strength in cancer patients can bring any further improvement in their treatment and lives.Material & Methods:This prospective study was conducted in a tertiary care hospital where 40 cancer patients were included on the basis of some criteria (isolated, silent, mentally shocked, paralyzed, poor PS, patient with severe pain, end-stage disease). They were taken to a silent room and were asked to follow some interesting instructions for 15 minutes with utmost belief in their GOD for successive three days. Data were collected by using a performed questionnaire from both patients and attendants after 14 days.Results:The result was appreciable. Out of 40 patients, females were more than males. Most of them were educated with a mean age of about 45 years. Patients with advanced disease were more (60%). Among them behavioral changes were observed in almost 80% of patients, improvement in mobility was found in almost 75 % of all paralyzed patients, narcotics dependency was reduced in almost 90 % of patients with severe bone pain, and positive attitudes were built in 80% patients. Therapeutic responses were also increased in some patients. Moreover, among most of the patients some interesting findings like improved healing power, decreased CT-induced toxicities, improvement in a familial relationship, improvement in appetite, and improvement in sleep disturbance were observed.Conclusion:Patients with cancer in spite of craving for life, begin counting/her days after being aware of this disease. As a result, this terror of death creates a sense of hopelessness and this psychological breakdown affects the treatment in such a way that even the best medical care does not work as expected. This study has successfully found that if the mental spirit of a patient can be brought to work with all the medical procedures, a certain success is possible. They just have to be made confident enough to believe that “a man”, as Ernest Hemmingway says, “can be destroyed, but not defeated”.

Alterações neurológicas e psiquiátricas crônicas devido à Covid-19 / Chronic neurological and psychiatric alterations due to Covid-19

Desde os primeiros relatos do novo coronavírus na China em 2019, houve uma disseminação rápida e severa desta patologia, acarretando milhões de mortes. Dessa forma, ao longo deste período, um dos principais focos de toda a comunidade científica foi o estudo das implicações da Covid-19 no organismo humano em curto, médio e longo prazo. Dessas pesquisas, surgiram diversas descobertas relacionas à implicação no vírus no sistema nervoso central e sistema nervoso periférico, principalmente a longo prazo, e não associadas apenas a questões neurológicas, mas também psiquiátricas e neurocirúrgicas. Entre as alterações mais relatadas, vemos: cefaleia, ageusia, anosmia, alteração de consciência, AVE, convulsão, meningite, depressão, ansiedades, transtorno de humor, entre muitas outras. Tendo em vista esta vasta gama de patologias, o estudo sistemático e padronizado das implicações se faz imprescindível e é desenvolvido neste artigo de revisão.

Ever since the first reports of the new coronavirus in China in 2019, there has been a fast and severe dissemination of this pathology, leading to millions of deaths. Throughout this period, one of the main cornerstones of the scientific community has thus been the study of COVID-19 implications to the human body in the short, medium, and long term. From this research, various discoveries have emerged regarding the implication of the virus in the central and peripheral nervous systems, especially in the long term; these are not only associated with neurological issues but also to psychiatric and neurosurgical ones. Among the most commonly reported alterations are headaches, ageusia, anosmia, altered states of consciousness, strokes, seizures, meningitis, depression, anxiety, mood disorders, and others. Considering this wide range of pathologies, a systematic and standardized study of these implications is thus indispensable and is carried out in this review article.

Aberrant right subclavian artery: a series of case reports and discussion of morphology and its clinical and surgical implications / Arteria subclavia derecha aberrante, una serie de informes de casos y discusión de la morfología y sus implicaciones clínicas y quirúrgicas

SUMMARY: Aberrant right subclavian artery (arteria lusoria) is a rare embryological abnormality but the most common among aortic arch vascular anomalies. It represents an anatomical variant of right subclavian artery originating as the last branch of aortic arch, passing then retroesophageal to the normal position. It is usually asymptomatic and is found mostly incidentally during imaging examinations. Symptoms are produced when the aberrant artery compresses the nearby structures and the most frequent symptoms are dysphagia and dyspnea. It may be associated with other vascular or heart abnormalities. We are presenting a series of case reports which presented an aberrant right subclavian artery alone or associated with other vascular abnormalities, diagnosed incidentally in adult patients while performing CT examinations for other reasons. Through a literature review we aim to discuss the clinical implications of this vascular anomaly, to point out the importance of being aware of it especially in patients with dysphagia or dyspnea or in patients who undergo operations in the thorax and neck or vascular surgery and endovascular procedures involving the aortic arch and its branches.

RESUMEN: La arteria subclavia derecha aberrante (Arteria lusoria) es una anomalía embriológica rara, pero la más común entre las anomalías vasculares del arco aórtico. Representa una variante anatómica de la arteria subclavia derecha que se origina como la última rama del arco aórtico, pasando luego retroesofágicamente a la posición normal. Por lo general, esta anomalía es asintomática y se encuentra principalmente de manera incidental durante los exámenes de imagen. Los síntomas se producen cuando la arteria aberrante comprime las estructuras cercanas y los síntomas más frecuentes son la disfagia y la disnea. Puede estar asociado con otras anomalías vasculares o cardíacas. Presentamos una serie de informes de casos en los que se presentó una arteria subclavia derecha aberrante única o asociada a otras anomalías vasculares, diagnosticada incidentalmente en pacientes adultos durante la realización de TC por otros motivos. A través de una revisión bibliográfica pretendemos discutir las implicaciones clínicas de esta anomalía vascular, señalar la importancia de conocerla especialmente en pacientes con disfagia o disnea o en pacientes sometidos a operaciones de tórax y cuello o cirugía vascular y procedimientos endovasculares. involucrando el arco aórtico y sus ramas.

El sentido de la violencia y el desplazamiento / The sense of violence and displacement

La teoría expuesta en el presente texto se relaciona con los sentimientos de las perso-nas víctimas del desplazamiento forzado; además del sometimiento al ser parte de una estructura sociocultural que vulnera su dignidad e identidad, obligándolo a permanecer oculto y en silencio porque el miedo no le ofrece alternativas. Dado lo anterior se men-cionan elementos afines con el sentido del sufrimiento y su relación con el significado y significantes de la violencia y el desplazamiento, señalando transformaciones del sen-tido de ambos fenómenos socioculturales a partir de la implicación psicosocial, esgri-miendo reflexiones que surgen de algunas prácticas investigativas y de intervención en una situación concreta en tiempo, lugar y espacio

The theory presented in this text is related to the feelings of the victims of forced displacement; in addition to the subjugation of being part of a sociocultural structure that violates their dignity and identity, forcing them to remain hidden and silent because fear does not offer alternatives. Given the above, elements related to the meaning of suffering and its relationship with the meaning and signifiers of violence and displacement are mentioned, pointing out transformations of the meaning of both sociocultural phenomena from the psychosocial implication, wielding reflections that arise from some research and intervention practices in a concrete situation in time, place and space

Clinical and surgical implications of the pulmonary azygos lobe: a systematic review / Implicaciones clínicas y quirúrgicas del lóbulo ácigos pulmonar: una revisión sistemática

SUMMARY: Azygos lobe is one of the most common pulmonary variations. Although numerous studies discuss to the clinical and surgical implications of anatomical variations, there are few investigations about this topic. The aim of this study was to discuss the anatomy of the pulmonary azygos lobe and its possible clinical and surgical correlations. In this systematic review, a total of 48 results were found between 1968 and 2020. After application of eligibility criteria, 16 articles were included to analysis. Our results showed there were no reports of surgery complications in azygos lobe presence. In all articles that described the anatomical variation, the pulmonary azygos lobe received tertiary segmental branches. Among the surgical implications in the presence of the azygos lobe, complications are of low complexity. It is necessary to teach about this anatomical variation in medical schools in cadavers. Emphasizing the obvious morphological modifications in the superior mediastinum.

RESUMEN: El lóbulo ácigos es una de las variaciones pulmonares más comunes. Aunque numerosos estudios discuten las implicaciones clínicas y quirúrgicas de las variaciones anatómicas, existen pocas investigaciones sobre este tema. El objetivo de este estudio fue discutir la anatomía del lóbulo ácigos pulmonar y sus posibles correlaciones clínicas y quirúrgicas. En esta revisión sistemática se encontraron un total de 48 resultados entre los años 1968 y 2020. Después de la aplicación de los criterios de elegibilidad, 16 artículos fueron incluidos para análisis. Nuestros resultados mostraron que no hubo informes de complicaciones quirúrgicas en presencia del lóbulo ácigos. En todos los artículos que describieron la variación anatómica, el lóbulo ácigos pulmonar recibió ramas segmentarias terciarias. Dentro de las implicaciones quirúrgicas en presencia del lóbulo ácigos, las complicaciones son de baja complejidad. En las escuelas de medicina es necesaria la enseñanza en cadáveres de esta variación anatómica, destacando las evidentes modificaciones morfológicas en el mediastino superior.

Recomendaciones para la investigación psicológica con personas transgénero: Una aproximación desde una experiencia en Chile / Recommendations for psychological research with transgender people: an approach from an experience in Chile

Resumen El presente trabajo expone y fundamenta recomendaciones basadas en la experiencia de investigación en personas transgénero, con la intención de que puedan ser útiles a quienes realicen estudios con dicha población. Estas recomendaciones incluyen orientaciones conceptuales, metodológicas y éticas, aplicables a lo largo del proceso de investigación. En particular, las orientaciones cubren los siguientes temas: definir con precisión el colectivo con el que se trabaja, registrar la variedad de identificaciones de género posibles al interior del mismo, utilizar métodos de muestreo aptos para poblaciones de difícil acceso, retribuir la participación, incluir líderes e investigadores transgéneros como expertos, pilotar los instrumentos en la población que será investigada, optar por modalidades de recolección grupal de datos, ofrecer asistencia individualizada durante la recolección, utilizar un lenguaje no estigmatizante e inclusivo, convocar la participación en conjunto con organizaciones transgénero, atender a la movilidad geográfica de la población, realizar una escucha comprometida y contemplar protocolos de derivación, considerar las diferentes trayectorias de transición, realizar sesiones de interanálisis y, finalmente, difundir apropiadamente los hallazgos al interior de la población transgénero. Se discuten estas proposiciones en términos de sus efectos en las comunidades trans, su utilidad y alcances éticos, su articulación con exigencias generales de toda investigación y sus implicaciones para el activismo.

Abstract Prejudice and discrimination have important effects on the well-being and quality of life of trans people. Hence, investigating with said population implies, in addition to actions to obtain relevant and truthful information, having the necessary actions to attend to their needs and peculiarities. These are populations that are difficult to access (hard-to-reach), stigmatized, in which there is no defined sampling frame, that have physical and mental health indicators lower than those of any other group with which we have worked and that, therefore, it is necessary to take extreme the precautions not to reproduce types of relationships that may be harmful or offensive. The purpose of the present article was to systematize part of our field experience with transgender people, so that it can be useful for those who study with this population. These recommendations aim to provide some conceptual, methodological and ethical guidelines, useful throughout the research process. In particular, we made a series of recommendations that cover from the moment of taking conceptual decisions about the design of the study, through contact with the organizations, until the completion of the field work and subsequent stage of dissemination of results. In particular, a series of recommendations are made regarding: specifying the definition of the group with which one works, recording the variety of gender identifications as people present them, using to sampling methods for hard-to-reach populations or hidden populations, deliver a retribution for the participation (consider participants as experts to be compensated for their work), including activists as experts in every stage of the study (study design, field work, data analysis and dissemination of results), piloting the instruments in specific population, preferably opt for group applications modality and continue with a debriefing, have specific assistance for participants during the application (special needs derived from their age, educational level, reduced mobility, among others), use non-stigmatizing and inclusive language, call together with trans organizations (in order to establish greater trust in the population), attend to a mobility of the population (so as not to replicate the sample in different places), carry out a committed listening and contemplate referral protocols (if necessary given the type of situations described by the participants and their current degree of elaboration), consider different trajectories of transition, conduct inter-analysis sessions and disseminate appropriately within the transgender population. These propositions are discussed in terms of their effects on trans communities, their usefulness and ethical scope, their articulation with the general requirements of all research, and their implications for activism. On the other hand, these recommendations can serve as criteria for evaluating the ethical dimension of research projects with trans people. It may therefore be important to project reviewers, editors, and reviewers of manuscripts submitted for publication. The perspective that we assume in this work is aligned with those called "evidence-based activism", which implies articulating a variety of knowledge, scientifically accredited and of an "experiential" type, in order to explore situations in which the team members Research staff are part of networks that involve them personally in their study topics. It is precisely the relationship with groups that work for the rights of minorities, activists and members of these groups is essential, since they have knowledge acquired through their experience as part of discriminated groups and they can contribute to the mobilization of knowledge in the governance of health issues.

Tumor-derived exosomes: Nanovesicles made by cancer cells to promote cancer metastasis

Nanomedicine usually refers to nanoparticles that deliver the functional drugs and siRNAs to treat cancer. Recent research has suggested that cancer cells can also make nanoparticles that also deliver functional molecules in promoting cancer metastasis, which is the leading cause of various cancer mortalities. This nanoparticle is called tumor-derived vesicles, or better-known as tumor-derived exosomes (TEXs). TEXs are nanoscale membrane vesicles (30-140 nm) that are released continuously by various types of cancer cells and contain tumor-derived functional biomolecules, including lipids, proteins, and genetic molecules. These endogenous TEXs can interact with host immune cells and epithelial cells locally and systemically. More importantly, they can reprogram the recipient cells in favor of promoting metastasis through facilitating tumor cell local invasion, intravasation, immune evasion, extravasation, and survival and growth in distant organs. Growing evidence suggests that TEXs play a key role in cancer metastasis. Here, we will review the most recent findings of how cancer cells harness TEXs to promote cancer metastasis through modulating vascular permeability, suppressing systemic immune surveillance, and creating metastatic niches. We will also summarize recent research in targeting TEXs to treat cancer metastasis.

Implications of iodine deficiency by gestational trimester: a systematic review

ABSTRACT As pregnant women are susceptible to changes in iodine, which can cause miscarriage, goiter, thyroid nodules, hypothyroidism, in addition to fetal neurological impairment or development. The aim of this study was to verify the implications of the iodine alteration in each gestational trimester and its consequences of physiological justification. The review was based on PRISMA. Searching for articles that took place in March 2020 without delimiting data. As bases consulted were the Clinical Trials, Cochrane Library, Lilacs and Medline (PubMed). The descriptors were combined as follows: "pregnancy" AND "iodine deficiency". Articles that addressed iodine deficiency and its implications were included. The selection followed the steps of reading the titles, abstracts and full articles. To assess the methodological quality of the studies, the STROBE Instruction instrument was used. The research resulted in 1,266 studies and 11 were included. In assessing methodological quality, the lowest score was and the maximum 20. According to studies, the fourth most affected by iodine loss are the second and third, it is possible to increase the volume and pneumatic nodules, subclinical hypothyroidism, pre-eclampsia, among others. The damages caused by iodine deficiency in the first or second trimester are still reversible, therefore, they need to be diagnosed early, to guarantee an iodic homeostasis and prevent damage to the health of the mother-child binomial.

COVID-19 and Its Implications in Dental Care

COVID-19 was first reported in Wuhan, Hubei Province of China a few months ago (December 2019) and had since become a major challenging public health problem for not only China but also many countries around the world. It was on March 11, 2020, characterized by WHO as a pandemic. The pandemic so far has killed more than 526,465 people and infected more than 11,046,917 people around the world as of 05 July 2020. Nigeria currently has 28,167 confirmed COVID-19 cases with 11,462 (40%) discharged, 16,071 (57%) currently receiving treatment at designated facilities across the country and unfortunately 634 (3%) deaths as at the time of writing this manuscript. As far as the authors are aware, there are little or no work carried out on the implications of COVID-19 on dental practices in Nigeria. Recently, COVID-19 was identified in saliva of infected patients and so transmission via aerosols and splatter generated during dental procedures is sure. To limit exposure, there was a need to avoid scheduling patients except for emergency dental care during this outbreak. This limitation on activities of the dental sector has a very huge impact on the economy of the sector as it has already resulted in serious monetary implications for dental practices worldwide. While dental practices in the high-income countries are getting help from their respective Government, those in the middle and low-income countries like Nigeria have been left to wallow in bankruptcy without support. The authors highly recommend that the Government of these neglected countries, step up and support dental practices that are on the brink of closing down due to the low turnout of patients to their practice during this outbreak.

COVID-19 y afectación cardíaca / Cardiac implications and COVID-19

The coronavirus pandemic has generated a serious global health problem. COVID-19 mainly affects the lung, but it has been seen that myocardial involvement also occurs in some patients, producing myocarditis and arrhythmias.

La pandemia por coronavirus ha generado un grave problema sanitario mundial. El COVID-19 afecta fundamentalmente el pulmón, pero se ha visto que en algunos pacientes también se produce afectación del miocardio produciendo miocarditis y arritmias.

Implicancias pronósticas de los márgenes quirúrgicos en el carcinoma oral / Prognostic implications of surgical margins in carcinoma of the oral cavity

Antecedentes: sobre la base de la bibliografía revisada y los resultados de supervivencia global y libre de enfermedad con diferentes márgenes de resección, se plantea la hipótesis de que márgenes < 5mm son suficientes para lograr una tasa de supervivencia global y comparables a las obtenidas con márgenes mayores. Objetivo: evaluar la supervivencia global y la supervivencia específica a 3 y 5 años de los pacientes con carcinomas escamosos de cavidad oral, en función de los márgenes quirúrgicos obtenidos. Material y métodos: se reclutaron entre enero de 2010 y diciembre de 2017 81 pacientes operados, 57,1%hombres, con una edad media de 60,49 años. Resultados: en el análisis multivariado en función de la supervivencia global y libre de enfermedad, resultaron variables pronósticas significativas el grado de diferenciación tumoral (p = 0,033), la invasión ganglionar extracapsular (p = 0,001) y la infiltración perineural (p = 0,000). Se pudo observar que no hay diferencias en la supervivencia libre de enfermedad de los diferentes grupos evaluados sobre la base de los márgenes quirúrgicos, pero se cree que la radioterapia posoperatoria estaría confundiendo la importancia real de los márgenes, debido a que la mayoría de los pacientes que presentaban márgenes cercanos fueron sometidos a radioterapia posoperatoria. Conclusiones: las variables analizadas concuerdan con la bibliografía en el sentido de que los únicos factores pronósticos resultan las características histológicas. Si bien existen muchos trabajos que analizan los márgenes en el carcinoma escamoso de cavidad oral, todavía no hay consenso en cuanto al valor pronóstico de los márgenes cercanos (1-5 mm).

Background: Based on the literature reviewed and the results of overall and disease-free survival with different surgical margins, we hypothesized that margins < 5mm are sufficient to achieve and overall survival rate and are comparable to those obtained with larger margins. Objective: The primary outcome of the present study was to evaluate overall survival and specific survival at 3 and 5 years of patients with squamous cell carcinoma of the oral cavity according to the surgical margins obtained. Material and methods: Between January 2010 and December 2017, 81 patients underwent surgery; 57.1% were men and mean age was 60.49 years. Results: At multivariate analysis, tumor differentiation (p = 0.033), extracapsular lymph node invasion (p = 0.001) and perineural invasion (p = 0.000) were identified as significant predictors of overall survival and disease-free survival. There were no differences in disease-free survival in the different groups evaluated based on the surgical margins. Yet, postoperative radiotherapy may actually obscure the importance of margins since most patients with close margins underwent postoperative radiotherapy. Conclusions: The variables analyzed in this paper are consistent with the literature in that only histological characteristics are prognostic factors. Although there are many studies analyzing the surgical margins in squamous carcinoma of the oral cavity, there is still no consensus regarding the prognostic value of close margins (1-5 mm).

Food–Drug Interaction And Their Clinical Implications: Selected Investigations

Food-drug interactions occur as a result of pharmacokinetic or pharmacodynamics mechanisms. Pharmacokinetic mechanisms include what the body does to a drug while Pharmacodynamics mechanisms involve what drugs do to the body. Many types of food have been shown to influence metabolism and the absorption of drugs. Large numbers of drugs are produced and introduced yearly. The interaction between Food and drug may cause negative effects in the nutritional status of the patient as well as safety and efficacy of drug therapy. Due to the possibility of unexpected or poor outcomes, generally, food-drug interactions, in this case, should be avoided. As the good clinical practice, drugs taken by mouth must be absorbed either through the lining of the stomach or the small intestine. Reduction in the absorbance of a drug might be influenced by the presence of food in the digestive tract. The avoidance of such interactions could be possible if the drug is taken 1 hour before or 2 h after eating the food. The effects of several types of food such as milk or milk products, grapefruit and grapefruit juice, bananas, oranges, legumes, fermented meats and pickled fish and some nutrient elements such as calcium, potassium, magnesium, iron, zinc, and vitamin K are highlighted in this paper including their clinical implications.

A Study On Variations Of Nutrient Foramen Of Humerus With Its Clinical Implications

Background: Nutrient foramen is an opening into shaft of humerus which gives passage to the blood vessels ofmedullary cavity. The knowledge of nutrient foramen is important in surgical procedures like bone grafting andmore recently in microsurgical vascularized bone transplantation. Lack of an adequate vascular supply cansignificantly delay or prevent fracture healing. Nutrient artery is the major source of blood supply to the longbone and hence plays an important role in fracture healing.Objective: The nutrient foramens obey the rule of ossification, that is directed away from the growing end of thebone or not.Materials and Methods: The present study consisted of 68 (34 right and 34 left) dried humeurus excluding anyfracture or pathological abnormalities. Number and direction of nutrient foramen was observed in each humerus.Location of nutrient foramen in relation with surfaces and zones of humeurus was determined.Result: It has been observed that 94.12% of the humerus had a single nutrient foramen, 6.39% double foramen,all humerus have nutrient foramina. It was concluded that the majority (73.61%) of the nutrient foramina werepresent on the antero-medial surface, 8.33% on the anterolateral surface and 8.33% on the posterior surface ofthe shaft of humerus and 8.33% of nutrient foramina present on anterior border. It was also concluded that most(86.11%) of the foramina present in the zone II followed by zone I (8.33%) then by zone III (5.56%). All foraminawere directed toward the lower end of humerus.Conclusion: By knowing the number and location of the nutrient foramina in humerus would be useful in preventingintra-operative injury of nutrient artery during orthopedic, plastic and reconstructive surgery and will also berelevant in medico legal practice.

Mediclaim insurance challenges and solutions – Doctors supporting patients: A Medic LAWgic initiative

INTRODUCTION:Because patients covered by medical insurance are being denied legitimate claims, doctors are working shoulder to shoulder with them and have garnered significant experience in this matter. We, therefore, decided to a systematic survey under the Medic LAWgic banner and presented the data.METHODS:A short, 8-question multiple-choice survey was conducted online among doctor clinicians. Duplicate replies were removed. The remaining replies were evaluated, interpreted, and the data are being presented here.RESULTS:A total of 377 doctors responded. The majority (208, 55%) had faced problems with medical insurance claims in more than 10% of their patients. Almost half of them (48%) had outright rejection of the claims in more than 10% of their patients. Reduction in claim amounts was faced in more than 10% instances by 262 (70%). The five most common causes for refusal or rejection of claims included failure of patient to disclose pre-existing illness (234, 62%), other insurance policy terms related issues (157, 42%), oral medication (199, 53%), treatment without admission (155, 41%), and treatment with new modes of therapy (152, 40%). As many as 301/377 (80%) doctors had written letters to the insurance companies for supporting their patients’ claim. Such supporting letters from the treating doctors resulted in the claim being accepted or approved in 216 instances (57%).DISCUSSION:Mediclaim denial is a major and growing problem. People who need financial assistance the most are also the most vulnerable to denial. In the USA, such denial rates ranged from 1% to 45% of in-network claims in the year 2017. Unfortunately, <0.5% of patients appealed such claim denial. The insurance regulatory and development authority of India (IRDA) have issued guidelines that all claims need to be settled within 30 days and that insurance companies must fulfill their contractual commitment for genuine claims, even if timely intimation was not possible. Insurance companies are running a business for profit. Hence, even the most expensive plans will have a list of exclusions, in the fine print. Indian patients need to be proactive in following up when claims are rejected or reduced. Doctors are their pillar of support, whose advantage needs to be taken by them. IRDA and consumer courts are also looking after patients’ rights in this matter.CONCLUSION:Patients are increasingly facing challenge of medical insurance companies denying legitimate claims. Doctors help by writing to the insurance companies supporting their patients claim and such letters help in the majority of instances. Patients and their families need to follow up aggressively when their claims are not approved, rejected or reduced. They should also request the help of their doctors when facing such challenges.