The harmful effects of smoking cigarettes on human health are well documented; thus various smoking cessation methods have been assessed and new options are currently under development to provide a “better’ alternative to the “worse” one, namely smoking. However, no ideal method of ending or replacing conventional smoking has been developed so far, and actually, none of them has been proven entirely effective or safe. The laxity, or rather the absence of regulations in the first decade of existence of electronic nicotine delivery systems (ENDS) allowed their use with prohibited substances instead of nicotine or other substances with detrimental effect, with the emergence of a severe syndrome - e-cigarette and vaping-associated lung injury (EVALI), whose treatment required even lung transplantation in young people without any prior underlying lung disease. This narrative review aims to provide a brief overview of concerns about medical issues associated with e-cigarette use, particularly cardiovascular and respiratory panels. We organized the data in several micro-sections varying from practical aspects of understanding ENDS to clinical issues. To combat tobacco addiction, electronic cigarettes are increasingly widely accepted. A global regulatory framework is required to prevent the emergence of an illicit e-cigarette business with detrimental impacts on health.
Background: Duct to mucosa Pancreatico-gastrostomy (DMPG) is a method for reconstruction of pancreatic mass following pancreaticoduodenectomy (PD). There are still controversies about the benefits of this surgical technique compared to the old ones. Objectives: This study aimed to evaluate the long-term outcomes of DMPG reconstruction following PD operation. Method: Through a prospective observational setting, 164 patients, undergoing PD surgery, with diagnosed pancreatic head or peri-ampullary cancer, were enrolled. A pylorus-preserving PD and DMPG were done for all patients to reconstruct the pancreatic mass. Patients were followed up to a mean of 21.06±14.12 months. Demographic data, risk factors, tumoral staging, and postoperative follow-up data were collected for the analytic study. Results: The mean survival of the patients was 21.06±14.23 months after surgery. DGE (delayed gastric emptying) (34.75%), pancreatic fistula (21.34%), bile duct fistula (7.31%), and hemorrhage (5.5%) were recorded as the most important complication in patients. Some post-operative complications were significantly observed in patients with diabetes mellitus (pancreatic fistula, increased amylase, and DGE), Smokers (bile duct fistula, hemorrhage, and increased Amylase), and the elders (bile duct fistula) (p-value <0.05). Conclusions: Although our results indicate that DMPG reconstruction is a safe technique, our findings did not confirm the priority of this method over the older techniques.
Resilience refers to the means and ability to deal with adverse conditions. Resilience is defined as the ability of the system to recover easily after disturbances and changes in the system and the ability of the organization to respond quickly to them. The resilient system can withstand environmental pressures so that it can provide optimal performance in critical situations. Resilience in the use of healthcare services is related to reducing vulnerability to shocks caused by natural disasters and increasing adaptive capacity due to improved measures and opportunities. Considering the importance of evaluation, monitoring, and planning to improve user resilience against accidents, spatial evaluation and redefinition of the use of health and medical services to prepare a comprehensive model for measuring the resilience of hospitals against accidents and calamities Naturally, at the top of which is the coronavirus epidemic, it is necessary. The aim of the current study is a comprehensive review of the factors influencing the redefinition of the spatial pattern of therapeutic uses in big cities at the time of the emergence of a pandemic disease with a resilience approach. It is expected that the managers and decision-makers of the country's health field can use the results of the present research for better planning.
The laboratory tests that should be performed and their frequency during isotretinoin treatment are controversial. We wanted to investigate muscle and joint pain and laboratory tests in acne patients who received isotretinoin. Between April 2019 and February 2023, serum CK, AST, ALT, and GGT levels were retrospectively evaluated in acne patients before and three months after systemic isotretinoin treatment. This study included 410 patients. The median serum AST, ALT, and GGT levels significantly increased, whereas serum CK levels were similar in all patients three months after treatment. 23 (5.6%) patients revealed muscle or joint pain after treatment. No significant difference was detected in patients with or without pain in the median serum CK, AST, ALT, and GGT levels after treatment. Isotretinoin treatment at a dose of 10 mg/day was more common in patients with pain than in those without pain, whereas none of the patients who received isotretinoin 40 mg/day developed muscle or joint pain. We suggest that routine evaluation of serum CK levels is unnecessary in acne patients treated with isotretinoin. However, muscle and joint pain may develop even at doses as low as 10 mg/day. Furthermore, monitoring AST, ALT, and GGT levels may be beneficial in acne patients treated with isotretinoin.
Background: Head and neck cancers, and particularly, oral cancers have a complex pathogenesis that includes genetic mutations and epigenetic alterations which interfere with cellular signaling and can trigger tumor development. The purpose of this study was to reveal whether low-frequency hotspot mutations may be detected in a study lot with histopathological evidence of squamous cell carcinoma (SCC) of the oral mucosa and skin of the head and neck. Methods: Tumor biopsies from treatment- naïve patients were tested for BRAF V600, NRAS G12/G13, NRAS Q61, KRAS Q61 mutations, and EGFR exon 19 deletions (Ex19Del) using droplet digital PCR (ddPCR). The tumors were also analyzed for EGFR T790M mutations by RT-PCR, using a CE-IVD validated kit, with a limit of detection of 0.05%. Results: None of the examined cases exhibited NRAS G12/G13, NRAS Q61, KRAS Q61, BRAF V600, or EGFR T790M mutations, indicating that these alterations are rare events in SCC pathogenesis. Interestingly, among the 12 specimens tested by ddPCR for EGFR Ex19Del, an HPV-negative cSCC tumor occurring in the parotid region tested positive for this drug-sensitizing mutation, offering unexplored therapeutic perspectives to the patient from whom it was collected. Conclusions: Our study highlights the important clinical implications of detecting low-frequency hotspot mutations in tumor biopsies by ddPCR. We believe that the ddPCR-assisted analysis of these mutations in larger SCC cohorts may provide us with mechanistic insights regarding their role in SCC pathogenesis and guide the development of novel therapeutic strategies for this problematic disease.
This study investigates the influence of experience on stress responses and fine motor skills among professional male military parachutists. We analyzed 132 paratroopers, divided into a non-experienced group (NEG; ≤6 parachute jumps) and an experienced group (EG; >50 jumps). Baseline samples were collected 2.5 hours before participants performed a 500 m jump, with post-jump evaluations conducted immediately after landing. Results indicated that experience significantly influences fine motor skills and stress responses. Non-experienced jumpers showed greater degradation in fine motor skills and higher cortical arousal pre-jump levels, suggesting an increased anticipatory state. In contrast, experienced parachutists maintained more consistent fine motor skills and exhibited a ceiling effect in stress response. Leg strength was higher in non-experienced jumpers, reflecting youth and greater muscle mass, with no significant difference in hand strength. These findings highlight the role of experience in managing stress and maintaining motor skills under pressure. The study suggests further exploration into psychological aspects like motivation and resilience, along with the long-term effects of stress exposure. The importance of experience in high-stress military operations emphasizes the need for targeted training interventions to enhance stress-coping mechanisms in less experienced individuals.
The rise of antimicrobial resistance poses a significant challenge to global health. This study investigates the antimicrobial properties of Taraxacum officinale and Chelidonium majus. Taraxacum officinale, commonly known as dandelion, has been utilized for centuries in traditional medicine for its various therapeutic benefits, including treating cholecystitis, enhancing hepatic function, regulating blood pressure and cholesterol levels, and exhibiting diuretic effects. Additionally, research has indicated that infusions derived from this plant offer favorable outcomes in managing renal diseases. This study aims to assess the antimicrobial activity of extracts from Taraxacum officinale and Chelidonium majus employing qualitative screening, quantitative determination, and in vitro evaluation of anti-biofilm properties. In vitro evaluation of the antibiofilm activity of plant products revealed their ability to inhibit the development of biofilms on inert substrate; plant extracts of C. majus were found to inhibit biofilm formation in all bacterial strains tested, while tincture of T. officinale showed very good activity on gram-negative and fungal strains. The results obtained are promising, supporting further research into the biochemical characteristics of these extracts in order to formulate strategies for the control of bacterial and fungal infections in humans.
Background: The deficit of medical staff in various health care systems points out the need for a more detailed strategic management toward sustainability in human resources. The purpose of this study is to explore the relationships linking self-esteem, self-efficacy, general attitudes, and career preferences among medical students, aiming to provide insights that could support sustainable career development. Methods: We performed a monocentric observational study that included 157 students. The participants completed four standardized questionnaires evaluating the self-efficacy, the self-esteem, the general attitudes and beliefs, and the perception of medical career specialty. We assessed the relationships between the psychological variables and career preferences. Results: Significant correlations emerged between the students' year of study and the need for achievement, the importance of mentorship, and career decision-making. Clinical students, in particular, placed greater emphasis on gaining practical experience in their chosen field. Conclusions: Our results reaffirm the impact of occupational psychology in the health care system, providing more sustainability in career decisions. Further research involving larger and more diverse samples is recommended to gain a more comprehensive understanding of how the study of various psychological factors could impact human resources management in the field.
Combat medics must deploy multiple cognitive, manual, and social skills to perform efficient life-saving interventions and ensure the safe transportation of casualties. In 2021, the Tactical Medical Training Cell of the Belgian Army introduced an immersive and integrative educational program for Advanced Emergency Medicine Technicians (EMTa) certification. This study aims to provide a correlational analysis of performance outcomes during the certification period. While conducting their assessment, candidates were evaluated in three different but complementary roles: Medical Leader (ML), Medical Practitioner (MP), and Tactical Leader (TL). The individual outcomes in theoretical and practical examinations of one hundred thirty-seven candidates were collected during 2021 and 2022. The mean success scores for the theoretical and total practical examinations were 90.6% and 80.1%, respectively. Candidates scored significantly better as TL. Theoretical results were significantly correlated with the ML function, and performances in all three positions were correlated with each other. This study showed that within the combat medic team, individual performances, even if initially well-defined, were associated with the success rates of the other positions. This finding should be considered in the further consolidation of combat medic education.
Effective communication is essential in healthcare, prompting the inclusion of communication courses in medical education. However, the effectiveness of such courses for Romanian medical students has not been evaluated. This pilot study investigates the impact of an ethical communication course on Romanian medical students' communication self-efficacy, communication skills, and the perceived importance of communication. Students attended a 3-month course on ethical communication, covering active listening, assertive communication, conflict management, non-verbal communication, patient- centered care, and ethical considerations in various medical fields. The course was developed based on the European Psychiatric Association guide regarding ethical aspects of communication with patients and their families. The data were analyzed on a sample of 24 students who completed the questionnaires at pretest and posttest. Students reported higher levels of medical communication self-efficacy and perceived importance of medical communication after the course. However, no statistically significant differences were found in health professionals’ communication skills. Future courses should include more patient interactions and varied teaching methods. Further research with larger samples and control groups is needed.
