This review explores the trajectory of photoplethysmography (PPG) technology from its inception in 1934 to its integration into smart devices in 2013. While PPG has proven effective in estimating left ventricular ejection time (LVET) and distinguishing between hypertensive and normotensive patients, challenges persist. The need for a robust mathematical model to explain physiological behaviors, address calibration protocols, and handle waveform variability is emphasized. Despite limitations, PPG is on the cusp of achieving clinical-grade confidence, particularly in estimating blood pressure and tracking vasomotor states. Integration into wearable devices is a prominent trend, with major companies exploring applications for improved health monitoring. Open-source databases and the availability of physiological data aim to enhance understanding, paving the way for universally accepted protocols. As PPG advances, it holds promise for personalized healthcare, revolutionizing treatment evaluations and preventive measures. However, potential disagreements over protocols may impede progress. Nevertheless, the technology's potential to remotely monitor cardiovascular markers could reduce physicians' workload for routine tasks. PPG stands as a beacon for the future of noninvasive cardiovascular assessment.
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.
Bariatric surgery represents one of the most efficient treatments addressing obesity and its associated complications with an increasing trend. Even if the medical benefits for patients are huge, due to weight loss and despite technical improvements in bariatric procedures, it is still associated with diverse types of complications. Most of the complications appear due to nutrient deficiency, as absorption is compromised after surgical anatomy modification. Neurological complications after bariatric surgery are very diverse with an occurrence within days to years after surgery, most frequently in patients with gastrointestinal or surgical complications. Any segment of the nervous system can be affected with distinct types of manifestations ranging from peripheral axonal neuropathy, nerve palsy secondary to compartment syndrome, encephalopathy, and myelopathy, to psychiatric and demyelinating central nervous system diseases. Identifying patients at risk and systematic screening for nutrient deficiency with proper supplementation is essential for preventing neurological complications and lifelong sequelae. In this paper, we present the spectrum of neurological complications reported after bariatric surgery.
Background. Primary headaches are comprised of three big categories: migraines (with or without aura), the third most common and the 6th most disabling disease worldwide, tension-headaches, and trigeminal autonomic cephalalgias, each with different, complex, and not completely understood pathophysiological, clinical, and neuroimagistic characteristics. Structures like the brain stem, hippocampus, or hypothalamus have been depicted as being the main triggers of these types of headaches, which have a significant impact on the quality of life. Methods. We performed a broad literature review on primary headaches from January 2016 to June 2023, analyzing the latest scientific updates and emphasizing the pathophysiological and neuroimagistic characteristics. Results. We provide a concise review of the main neuroimaging studies that help in differential diagnosis between several types of primary headaches. Conclusions. It is difficult to approach the pathophysiology of these three primary headache categories. Keeping in mind that neuroimagistic methods are rapidly developing (especially in the MRI sphere), the most important endpoint of future studies will be to establish a reliable distinction system for all these types of cephalalgias, thus updating the protocols and guidelines. Currently, imaging studies are indicated only in certain circumstances.
Background and aim: Influenza, commonly referred to as "the flu," is an infectious illness caused by influenza viruses (IV). Despite the availability of efficient antiviral drugs, the IV still significantly increases mortality. Antiviral drugs swiftly remove these viruses from pulmonary secretions, suggesting that a prolonged inflammatory response may be to blame for the poor result. Therefore, using immunomodulatory medications looks advantageous. Numerous anti-inflammatory effects are produced by statins. Numerous retrospective studies recommended that statins be considered for IV therapy. This study set out to comprehensively examine the immunomodulatory potential of statins in IV prophylaxis and therapy. Methods: From the beginning until 25 March 2022, a number of electronic databases (Scopus, EMBASE, PubMed, Web of Science, ProQuest, OVID, EBSCO, and CINAHL) were searched for cohort studies and randomized trials assessing the association between outcomes or risk of infections and statin therapy. Data were gathered on the investigated characteristics, measuring statin usage, quality evaluation, and results (set for potential confounders). Results: Finding additional therapeutic agents for influenza prevention and management is crucial since there are uncertain public health issues regarding the clinical efficacy of conventional medications. Pro-inflammatory cytokines are released as a result of influenza. According to the results, by using antiinflammatory medications, severe influenza infections can be prevented along with pleiotropic effects. As a result, statins, which are cardioprotective medications with immunomodulatory and anti-inflammatory properties, may be beneficial for individuals with IV. Conclusion: Based on the positive immunomodulatory effects of statin administration, our systematic review's findings suggested that IVs may be prevented and treated.
