Medicinal bismuth: Bismuth-organic frameworks as pharmaceutically privileged compounds

Historically organometallic compounds have been used to cure certain diseases with limited applications. Although bismuth belongs to the category of heavy metals, many of its derivatives have found applications in modern drug discovery research, mainly because of its low toxicity and higher bioavailability. Being an eco-friendly mild Lewis acid, compounds having bismuth as a central atom are capable of binding several proteins in humans and other species. Bismuth complexes demonstrated antibacterial potential in syphilis, diarrhea, gastritis, and colitis. Apart from antibacterial activities, bismuth compounds exhibited anticancer, antileishmanial, and some extent of antifungal and other medicinal properties. This article discusses major synthetic methods and pharmacological potentials of bismuth complexes exhibiting in vitro activity to significant clinical performance in a systematic and timely manner.Copyright © 2022 Elsevier Ltd

Outcome of cancer patients with COVID-19: the VCU experience

Purpose: COVID-19 has deeply impacted the care and prognosis of those with preexisting acute and chronic conditions including cancer. The purpose of this study is to identify risk factors contributing to death from COVID-19 infection in the cancer population at Virginia Commonwealth University Health System (VCUHS). Materials and Methods: 507 patients were evaluated that had a diagnosis of any solid or hematologic malignancy and admitted to the inpatient service at VCUHS while having a COVID-19 PCR positive test between February 2020 and June 2021. Patient characteristics as well as comorbidities, transplant status, ventilator dependence, intensive care admission, and malignancy type were recorded. Death was recorded as being due to COVID-19 or COVID-19 complications. Logistic regression model was used to determine odds ratio (OR) of death from COVID 19. Results were listed with respective OR both unadjusted and adjusted for age, race, sex, body mass index (BMI), and comorbidities including diabetes, chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), and chronic kidney disease (CKD). Results: Of the 507 patients, 37 experienced death (7.3%). Only 40 patients required ICU admission (7.9%) and 24 required ventilator support (4.7%). Increased age per 5-year increments was associated with increased risk of death in adjusted and unadjusted analysis (OR 1.30 (1.06,1.63) and 1.26 (1.10,1.46)). There was no significant risk of death in either adjusted or unadjusted analysis between Caucasian, African American, Asian or unspecified races. When not adjusted, COPD (OR 2.56, 1.28-5.11), CAD (OR 2.69, 1.36-5.32), and CKD (OR 2.14, 1.09-4.21) were all shown to have significant risk of death. However, when adjusted, there were no significant difference in odds ratio between patients with diabetes, CAD, COPD, and CKD. When adjusted, malignancies of central nervous system (CNS) (OR 70.30, 2.18-1520.3), hematologic (OR 4.79, 1.05-30.77), and head and neck (OR 11.64, 1.58-100.01) were at increased risk of death;while female associated malignancies, genitourinary (GU), lung, connective tissue, and those with multiple primary malignancies did not have significant risk. Ventilatory dependence did increase mortality risk (OR 50.54, 7.62,459.7), while transplant status and intensive care unit admission did not. Conclusions: Based on the results from this study, there is an increased risk of death from COVID-19 infections in several variables in the cancer population at VCUHS. Age, ventilator dependence, CNS, hematologic, and head and neck malignancies were all associated with increased mortality. Further evaluation will include the 13 other patients in which data was not yet available. Other variables that will be evaluated are COVID treatments, vaccination status, antibody formation, cancer treatment modality used within 30 days of COVID diagnosis, and lab values including cell counts and inflammatory markers.

Lariat Loop

Insertion of nasogastric tube is one of the commonest clinical procedures. However, very rarely, the tube can coil on itself to form something called a Lariat loop. This is a knot that can cause the tube to get stuck inside the pharynx and can precipitate emergencies like laryngeal obstruction or esophageal rupture. A brief discussion of a case along with the causes and prevention of this complication has been done.

Some Important Points in Oxygen Therapy: An Update for the Clinicians in the Covid Era

The use of oxygen has gained much prominence in the Covid era. However, there are still lacunae in the practical knowledge of health workers regarding proper use of this medical gas. Daily clinical experience still reveals instances of over-and under-use of oxygen. There are various aspects of oxygen use, including choosing the proper source, the proper delivery device, and the proper duration, which must be decided appropriately for maximum benefit of the patient. This article aims to present certain practical aspects of oxygen use for the clinician. While this is an essential knowledge for the Covid era, the learning will be useful for the future too.

A Lateral pragmatic method of surgical training -safe & effective during a pandemic

Purpose: Unknown infection risks with laparoscopy & endoscopy during the 1st wave of Sars-Cov2 pandemic and multifactorial limited theatre access resulted in a significant reduction in the delivery of surgical training. We proactively looked at pragmatic approach to compensate for the compromised training for a prolonged duration. Method: Two training enthusiast consultants were nominated as training leads of Gastro-intestinal Surgery at our institution. Surgical registrars, speciality doctors & core trainees of our department were individually assessed for their surgical & endoscopic competency with high-fidelity simulators. A Covid-Safe training environment was established at the Medical Education Centre (MEC) following discussion with the surgical & infection control lead clinicians, MEC, surgical equipment companies & animal tissue providers. Reduced elective work during the week facilitated a working rota of consultants over the weekends to provide a continuous set of wet lab open & laparoscopic training modules tailoring both technical & non-technical skill requirements of the individual trainees. Results: No infection related adverse event reported with the process. Since the recovery phase of the 1st peak of the pandemic, all endoscopy lists were changed to training lists resulting in three fold increased access to the trainees. Evaluation of wet lab-based all modules on a Likert scale revealed the highest score of effectiveness & satisfaction from all the trainees & the trainers. Conclusion: The endoscopy sessions for training & weekend wet lab skill stations during the pandemic were safe, effective & augmented morale of surgical trainees. Analysis of pre-post task skills-based competency is awaited to guide future parallel training modules.