How can youth involvement in public health conferences promote a tobacco-free generation? Lessons from the ECToH 2023's Youth Committee

Young health advocates have the legitimate aspiration to be masters of their future and are increasingly contributing to public health research and practice worldwide, yet their potential to contribute to the documentation and communication of outputs from public health conferences has not been fully realised. This short communication highlights the Youth Committee of the 2023 European Conference on Tobacco or Health as an example of youth involvement in a major public health conference focused on tobacco control. The authors explore the benefits, practicalities and challenges of incorporating young professionals into conference workflow, including creativity, networking and engagement with broader public health challenges within their communities. This article emphasises the active participation of Youth Committees in public health fora as a model for future conferences and underscores a commitment to achieving a tobacco-free generation.

Eco-Friendly and COVID-19 Friendly? Decreasing the Carbon Footprint of the Operating Room in the COVID-19 Era

Surgery is one of the most energy-intensive branches of healthcare. Although the COVID-19 pandemic has reduced surgical volumes, infection control protocols have increased the ecological footprint of surgery owing to the extensive use of personal protective equipment, sanitation, testing and isolation resources. The burden of environmental diseases requiring surgical care, the international commitment towards environmental sustainability and the global efforts to return to the pre-pandemic surgical workflow call for action towards climate-friendly surgery. The authors have searched the peer-reviewed and gray literature for clinical studies, reports and guidelines related to the ecological footprint of surgical care and the available solutions and frameworks to reduce it. Numerous studies concede that surgery is associated with a high rate of energy utilization and waste generation that is comparable to major non-medical sources of pollution. Recommendations and research questions outlining environmentally sustainable models of surgical practices span from sanitation and air quality improvement systems to the allocation of non-recyclable consumables and energy-efficient surgical planning. The latter are particularly relevant to infection control protocols for COVID-19. Paving the way towards climate-friendly surgery is a worthy endeavor with a major potential to improve surgical practice and outcomes in the long term.

Natural products derived from medicinal plants and microbes might act as a game-changer in breast cancer: a comprehensive review of preclinical and clinical studies

Breast cancer (BC) is the most prevalent neoplasm among women. Genetic and environmental factors lead to BC development and on this basis, several preventive - screening and therapeutic interventions have been developed. Hormones, both in the form of endogenous hormonal signaling or hormonal contraceptives, play an important role in BC pathogenesis and progression. On top of these, breast microbiota includes both species with an immunomodulatory activity enhancing the host's response against cancer cells and species producing proinflammatory cytokines associated with BC development. Identification of novel multitargeted therapeutic agents with poly-pharmacological potential is a dire need to combat advanced and metastatic BC. A growing body of research has emphasized the potential of natural compounds derived from medicinal plants and microbial species as complementary BC treatment regimens, including dietary supplements and probiotics. In particular, extracts from plants such as Artemisia monosperma Delile, Origanum dayi Post, Urtica membranacea Poir. ex Savigny, Krameria lappacea (Dombey) Burdet & B.B. Simpson and metabolites extracted from microbes such as Deinococcus radiodurans and Streptomycetes strains as well as probiotics like Bacillus coagulans and Lactobacillus brevis MK05 have exhibited antitumor effects in the form of antiproliferative and cytotoxic activity, increase in tumors' chemosensitivity, antioxidant activity and modulation of BC - associated molecular pathways. Further, bioactive compounds like 3,3'-diindolylmethane, epigallocatechin gallate, genistein, rutin, resveratrol, lycopene, sulforaphane, silibinin, rosmarinic acid, and shikonin are of special interest for the researchers and clinicians because these natural agents have multimodal action and act via multiple ways in managing the BC and most of these agents are regularly available in our food and fruit diets. Evidence from clinical trials suggests that such products had major potential in enhancing the effectiveness of conventional antitumor agents and decreasing their side effects. We here provide a comprehensive review of the therapeutic effects and mechanistic underpinnings of medicinal plants and microbial metabolites in BC management. The future perspectives on the translation of these findings to the personalized treatment of BC are provided and discussed.

Risk of arterial thromboembolism, bleeding and mortality in atrial fibrillation patients with comorbid cancer: A systematic review and meta-analysis

AIMS

Atrial fibrillation (AF) and cancer often co-exist. Each has been associated with an increased risk of morbidity and mortality. The aim of this meta-analysis was to synthesize available data regarding the incidence of arterial thromboembolism (TE), bleeding, and all-cause mortality in patients with AF with or without cancer.

METHODS

Literature search was conducted in PubMed, Ovid MEDLINE, WebOfScience, Scopus, CENTRAL, OpenGrey, and EThOS databases to identify studies that included patients with AF and accounted for cancer status with the incidence of TE (ischemic stroke, transient ischemic attack, or arterial thrombosis), major or clinically relevant non-major bleeding, and all-cause mortality. A random-effects meta-analysis was used.

RESULTS

Overall, 17 studies were included (3,149,547 patients). The risk of TE was similar in patients with AF with comorbid cancer compared with that in AF alone (pooled odds ratio [pOR] 0.97, 95% Confidence Interval [CI] 0.85-1.11, I2 = 87%). Major or clinically relevant non-major bleeding (pOR 1.65, 95% CI 1.35-2.02, I2 = 98%) and all-cause death (pOR 2.17, 95% CI 1.83-2.56, I2 = 98%) were significantly higher in patients with AF with cancer than in patients with AF only. The history of TE and hypertension and mean age were significant moderators of TE risk.

CONCLUSION

In patients with AF, the presence of cancer is associated with a similar risk of TE as well as an increased risk of bleeding and all-cause death compared with the absence of cancer.

Bone density optimized pedicle screw insertion

Background: Spinal fusion is the most common surgical treatment for the management of degenerative spinal disease. However, complications such as screw loosening lead to painful pseudoarthrosis, and are a common reason for revision. Optimization of screw trajectories to increase implant resistance to mechanical loading is essential. A recent optimization method has shown potential for determining optimal screw position and size based on areas of high bone elastic modulus (E-modulus). Aim: The aim of this biomechanical study was to verify the optimization algorithm for pedicle screw placement in a cadaveric study and to quantify the effect of optimization. The pull-out strength of pedicle screws with an optimized trajectory was compared to that of a traditional trajectory. Methods: Twenty-five lumbar vertebrae were instrumented with pedicle screws (on one side, the pedicle screws were inserted in the traditional way, on the other side, the screws were inserted using an optimized trajectory). Results: An improvement in pull-out strength and pull-out strain energy of the optimized screw trajectory compared to the traditional screw trajectory was only observed for E-modulus values greater than 3500 MPa cm3. For values of 3500 MPa cm3 or less, optimization showed no clear benefit. The median screw length of the optimized pedicle screws was significantly smaller than the median screw length of the traditionally inserted pedicle screws, p < 0.001. Discussion: Optimization of the pedicle screw trajectory is feasible, but seems to apply only to vertebrae with very high E-modulus values. This is likely because screw trajectory optimization resulted in a reduction in screw length and therefore a reduction in the implant-bone interface. Future efforts to predict the optimal pedicle screw trajectory should include screw length as a critical component of potential stability.

Spine Biomechanics in the Work of Aristotle (384 - 322 BC)

Background: Spine biomechanics is a field of applied research aiming to unravel the biomechanical understanding of the spine and its disorders and to understand the implications of their interventional therapy to improve clinical practice, physical performance and daily living. Its scientific whereabouts can be traced in the work of Aristotle, who discussed physical and biological concepts of spine biomechanics in a series of treatises.Results: The authors searched the Thesaurus Linguae Graecae archive for original texts written in Greek and attributed to Aristotle and selected excerpts of medical and biological treatises that elaborate on spine biomechanics.Discussion: While many of his theories have become outdated, his methodology and rationale remain relevant for contemporary researchers and clinicians. Here, the relevant content of passages of the corpus aristotelicum related to spine biomechanics and discuss their practical implications are presented.

Telemedicine in Care of Sarcoma Patients beyond the COVID-19 Pandemic: Challenges and Opportunities

BACKGROUND

The COVID-19 pandemic has created a challenging environment for sarcoma patients. Most oncology societies published guidelines or recommendations prioritizing sarcoma patients and established telehealth as an efficient method of approaching them. The aim of this review is the assessment of current evidence regarding the utilization of telemedicine in diagnosis, treatment modalities, telerehabilitation and satisfaction among sarcoma patients and healthcare providers (HP).

METHODS

This systematic review was carried out using the databases PubMed and Ovid MEDLINE according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

RESULTS

The application of telemedicine to the management of sarcoma has yielded improved clinical and psychological outcomes. Specifically, significant progress has been demonstrated in the areas of tele-oncology and telerehabilitation during the last decade, and the COVID-19 outbreak has accelerated this transition toward them. Telehealth has been proven efficient in a wide spectrum of applications from consultations on physical therapy and psychological support to virtual care symptom management. Both HP and patients reported satisfaction with telehealth services at levels comparable to in-person visits.

CONCLUSIONS

Telehealth has already unveiled many opportunities in tailoring individualized care, and its role in the management of sarcoma patients has been established in the post-COVID-19 era, as well.

Is surgery on the right track? The burden of wrong-site surgery

Surgery is a cornerstone of modern health care. Medical errors resulting from the clinical treatment of patients are a problem with global relevance. Among "never events," wrong-site surgery accounts for preventable mistakes with a big impact on patients as well as the economy. Wrong-site surgery has many contributing factors, whose identification is challenging. Nevertheless, it remains indisputable that wrong-site surgery affects patients' lives on many levels, ranging from physical disability to mental health. In addition, it aggravates the economic integrity of healthcare systems, healthcare workers' professional standards, and the public's trust in surgical services. Possible solutions for wrong-site surgery include perioperative protocols, surgical checklists, effective communication, education, continuous evaluation of existing procedures, and the implementation of new technology.

Biomechanical limitations of partial pediculectomy in endoscopic spine surgery

BACKGROUND CONTEXT

Transforaminal endoscopic decompression is an emerging minimally invasive surgical technique in spine surgery. The biomechanical effects and limitations of resections associated with this technique are scarce.

PURPOSE

The objective of this study was to analyze the effects of three different extents of reduction at the craniomedial pedicle (10%, 25%, and 50%) and to compare them with the intact native side. In addition, the influence of bone quality on the resistance of the pedicle after reduction was investigated.

STUDY DESIGN

Biomechanical cadaveric study.

METHODS

Thirty lumbar vertebrae originating from six fresh frozen cadavers were tested under uniaxial compression load in a ramp-to-failure test: (1) the reduced pedicle on one side, and (2) the native pedicle on the other side. Of the 30 lumbar vertebrae, ten were assigned to each reduction group (10%, 25%, and 50%).

RESULTS

On the intact side, the median axial compression force to failure was 593 N (442.4-785.8). A reduction of the pedicle by 10% of the cross-sectional area resulted in a decrease of the axial load resistance by 4% to 66% compared to the intact opposite side (p=.046). The median compression force to failure was 381.89 N (range: 336-662.1). A reduction by 25% resulted in a decrease of 7% to 71% (p=.001). The median compression force to failure was 333 N (265.1-397.3). A reduction by 50% resulted in a decrease of 39% to 90% (p<.001). The median compression force to failure was 200.9 N (192.3-283.9). At 10% pedicle reduction, the Hounsfield units (HU) value and the absolute force required to generate a pedicle fracture showed significant correlations (ρ=.872; p=.001). At 25%, a positive correlation between the two variables could still be identified (ρ=.603; p=.065). At 50%, no correlation was found (ρ=-.122; p=.738).

CONCLUSION

Resection of the inner, upper part of the pedicle significantly reduces the axial resistance force of the pedicle until a fracture occurs.

CLINICAL SIGNIFICANCE

The extent of pedicle reduction itself plays only a limited role: once the cortical bone in the pedicle region is compromised, significant loss of resistance to loading must be anticipated.

The Effect of Corticosteroids on Temporal Artery Biopsy Positivity in Giant Cell Arteritis: Timing is Everything

OBJECTIVE

Temporal artery biopsy (TAB) remains the standard criterion for the diagnosis of giant cell arteritis (GCA). Temporal artery biopsy is suggested to be performed within 2 weeks from the initiation of corticosteroids. However, the effects of TAB timing on the sensitivity of its findings still warrant further investigation.

METHODS

We reviewed the medical records of patients with GCA from a tertiary medical center in Germany over an 8-year period.

RESULTS

We analyzed data from 109 patients with a median age of 76 years and a median time from glucocorticoid treatment to TAB of 4 days. Approximately 60% of biopsies were positive. Our analysis yielded a nonsignificant trend toward shorter duration of corticosteroid treatment in the TAB(+) group ( p = 0.06). A more than 7 days' duration of steroid treatment was independently linked with lower rates of positive TAB (adjusted odds ratio, 0.33; 95% confidence interval, 0.11-1.00).

CONCLUSION

We conclude that the duration of corticosteroid treatment seems to affect the positivity of TAB in patients with suspected GCA. Further larger studies are required to confirm the generalizability of our findings.

Nanotherapy based on magneto-mechanochemical modulation of tumor redox state

Magnetic nanoparticles (MNs) are typically used as contrast agents for magnetic resonance imaging or as drug carriers with a remotely controlled delivery to the tumor. However, they can also potentiate the action of anticancer drugs under the influence of applied constant magnetic (CMFs) and electromagnetic fields (EMFs). This review demonstrates the role of magneto-mechanochemical effects produced by MNs alone and loaded with anticancer agents (MNCs) in response to CMFs and EMFs for modulation of tumor redox state. The combined treatment is suggested to act by two mechanisms: spin-dependent electron transport propagates free radical chain reactions, while magnetomechanical interactions cause conformational changes in drug molecules loaded onto MNs and generate reactive oxygen species (ROS). By adjusting the parameters of CMFs and EMFs during the magneto-mechanochemical synthesis and subsequent treatment, it is possible to modulate ROS production and switch redox signaling involved in ERK1/2 and NF-κB pathways from initiation of tumor growth to inhibition. Observations of tumor volume in different animal models and treatment combinations reported a 6%-70% reduction as compared with conventional drugs. Despite these results, there is a general lack of research in magnetic nanotheranostics that link redox changes across multiple levels of organization in the tumor-bearing host. Further multidisciplinary studies with more focus on the relationship between the electron transport processes in biomolecules and their effects on the tumor-host interaction should accelerate the clinical translation of magnetic nanotheranostics. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease Therapeutic Approaches and Drug Discovery > Emerging Technologies Nanotechnology Approaches to Biology > Nanoscale Systems in Biology.

Vertebropexy as a semi-rigid ligamentous alternative to lumbar spinal fusion

PURPOSE

To develop ligamentous vertebral stabilization techniques ("vertebropexy") that can be used after microsurgical decompression (intact posterior structures) and midline decompression (removed posterior structures) and to elaborate their biomechanical characteristics.

METHODS

Fifteen spinal segments were biomechanically tested in a stepwise surgical decompression and ligamentous stabilization study. Stabilization was achieved with a gracilis or semitendinosus tendon allograft, which was attached to the spinous process (interspinous vertebropexy) or the laminae (interlaminar vertebropexy) in form of a loop. The specimens were tested (1) in the native state, after (2) microsurgical decompression, (3) interspinous vertebropexy, (4) midline decompression, and (5) interlaminar vertebropexy. In the intact state and after every surgical step, the segments were loaded in flexion-extension (FE), lateral shear (LS), lateral bending (LB), anterior shear (AS) and axial rotation (AR).

RESULTS

Interspinous vertebropexy significantly reduced the range of motion (ROM) in all loading scenarios compared to microsurgical decompression: in FE by 70% (p < 0.001), in LS by 22% (p < 0.001), in LB by 8% (p < 0.001) in AS by 12% (p < 0.01) and in AR by 9% (p < 0.001). Interlaminar vertebropexy decreased ROM compared to midline decompression by 70% (p < 0.001) in FE, 18% (p < 0.001) in LS, 11% (p < 0.01) in LB, 7% (p < 0.01) in AS, and 4% (p < 0.01) in AR. Vertebral segment ROM was significantly smaller with the interspinous vertebropexy compared to the interlaminar vertebropexy for all loading scenarios except FE. Both techniques were able to reduce vertebral body segment ROM in FE, LS and LB beyond the native state.

CONCLUSION

Vertebropexy is a new concept of semi-rigid spinal stabilization based on ligamentous reinforcement of the spinal segment. It is able to reduce motion, especially in flexion-extension. Studies are needed to evaluate its clinical application.

SARS-CoV-2 induced HDL dysfunction may affect the host's response to and recovery from COVID-19

INTRODUCTION

Covid-19 is linked with the development of cardio-metabolic disorders, including dyslipidemia, dysregulation of high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Furthermore, SARS-Co-2 infection is associated with noteworthy changes in lipid profile, which is suggested as a possible biomarker to support the diagnosis and management of Covid-19.

METHODS

This paper adopts the literature review method to obtain information about how Covid-19 affects high-risk group patients and may cause severe and critical effects due to the development of acute lung injury and acute respiratory distress syndrome. A narrative and comprehensive review is presented.

RESULTS

Reducing HDL in Covid-19 is connected to the disease severity and poor clinical outcomes, suggesting that high HDL serum levels could benefit Covid-19. SARS-CoV-2 binds HDL, and this complex is attached to the co-localized receptors, facilitating viral entry. Therefore, SARS-CoV-2 infection may induce the development of dysfunctional HDL through different mechanisms, including induction of inflammatory and oxidative stress with activation of inflammatory signaling pathways. In turn, the induction of dysfunctional HDL induces the activation of inflammatory signaling pathways and oxidative stress, increasing Covid-19 severity.

CONCLUSIONS

Covid-19 is linked with the development of cardio-metabolic disorders, including dyslipidemia in general and dysregulation of high-density lipoprotein and low-density lipoprotein. Therefore, the present study aimed to overview the causal relationship between dysfunctional high-density lipoprotein and Covid-19.

COVID-19, Monkeypox, climate change and surgery: A syndemic undermines the right to be operated in a clean, healthy and sustainable environment

The compounding effect of infectious outbreaks and climate change has put a strain on surgical care. Adverse weather conditions derail preoperative planning, postoperative recovery, supply chains and equipment. The COVID-19 pandemic has restricted elective surgical care for the past two years. It is expected that novel SARS-CoV-2 strains and the emergence of Monkeypox can also put barriers to surgical care. Consecutively, mounting surgical morbidity and strenuous efforts to adhere to infection control further increase the ecological footprint of surgical care fueling a vicious circle of clinical and environmental challenges. Multilevel action from the side of surgeons and surgical societies is required. This includes creating contingency plans for sustainable surgical practice amidst public health emergencies, informing stakeholders and the public about the cumulative ramifications of the syndemic on surgery and promoting social participation among surgeons.

Subjective Assessments and Serum Cortisol Levels as Risk Factors of Pain Persistence in the Late Postoperative Period in Old and Oldest-Old Patients

Postoperative pain is one of the most common postoperative complications, resulting in significant burdens and adverse outcomes among patients, notably the frailest ones. Predicting the likelihood of intense postoperative pain can help optimize a patient's recovery. The aims of this study were to build a prognostic model of pain persistence in elderly and senile patients in the late postoperative period, based on clinical and laboratory parameters of the early postoperative period, and to evaluate the potential for the model's application. The study included 201 male and female patients who had undergone surgery of any type from September 2019 to August 2020. The patients were divided into three groups: senile patients, elderly patients, and young patients (control group). All of the examined patients were measured for fasting cortisol on the mornings of the first and seventh days following surgery. A statistically significant increase in the probability of pain persistence in the late postoperative period with the increasing age of the patient was found. Age, pain severity scores on the seventh day after surgery, and cortisol concentration in the blood on the first day after surgery, are of prognostic value for the risk of persistence of postoperative-pain syndrome.

Public Health Preparedness in the Era of Weather Modification and Climate Engineering

The use of technological and chemical means aiming to achieve favorable weather conditions or reduce the risk of weather extremes is known as Weather Modification (WM). The United States of America, the People's Republic of China, Thailand, the United Arab Emirates, and Europe have employed WM in an effort to prevent hurricanes and storms, control precipitations, mitigate deforestation and drought, and enhance agriculture. Recently, the use of WM has been expanded toward decreasing air pollution and creating favorable weather conditions for major political and athletic events. The increasing significance and use of WM call for consideration upon its positive and negative effects on human health, close collaboration among health experts and WM decision makers, and relevant public health emergency contingency planning.

Environmental sustainability in healthcare: Time to make outpatient care in orthopaedics and rheumatology greener

INTRODUCTION

Chronic musculoskeletal conditions affect billions of individuals and constitute the greatest contributor to disability worldwide. Climate change has a negative impact on these conditions, causing a rising number of patients seeking medical attention in outpatient orthopaedic and rheumatology clinics. Due to the COVID-19 pandemic, the delivery of care by these facilities tends to become more energy-intensive due to the increased usage of protective equipment and testing for the purpose of maintaining hygienic conditions. Therefore, practitioners and health bodies in the field need to take action to make their practice more environmentally sustainable and protect both the environment and their patients.

METHODS

The authors searched peer reviewed and grey literature for relevant sources.

RESULTS

The present review of the literature provides an overview of the environmental pollution associated with outpatient musculoskeletal care and discusses evidence-based recommendations from previous studies.

CONCLUSION

Telemedicine, rationalised use of consumables and equipment, physician-led climate advocacy and patient education have a major potential to turn the tide.

"Loved ones are not 'visitors' in a patient's life"-The importance of including loved ones in the patient's hospital stay: An international Twitter study of #HospitalsTalkToLovedOnes in times of COVID-19

Background

Hospitals are institutions whose primary task is to treat patients. Family-centered care, which considers loved ones as equal partners in patient care, has been gaining recognition in the adult care setting. Our aim was to record experiences of and opinions on communication between hospital-based healthcare providers and patients' loved ones, related but not limited to the rigorous mitigation measures implemented during the COVID-19 pandemic.

Methods

The Twitter profile @HospitalsTalkTo and hashtag #HospitalsTalkToLovedOnes were created to interact with the Twitter public between 7 June 2021 and 7 February 2022. Conversations surrounding #HospitalsTalkToLovedOnes were extracted and subjected to natural language processing analysis using term frequency and Markov chain analysis. Qualitative thematic analysis was performed on the 10% most interacted tweets and of tweets mentioning "COVID" from a personal experience-based subset.

Results

We collected 4412 unique tweets made or interacted by 7040 Twitter users from 142 different countries. The most frequent words were patient, hospital, care, family, loved and communication. Thematic analysis revealed the importance of communication between patients, patients' loved ones and hospitals; showed that patients and their loved ones need support during a patient's hospital journey; and that pediatric care should be the gold standard for adult care. Visitation restrictions due to COVID-19 are just one barrier to communication, others are a lack of phone signal, no space or time for asking questions, and a complex medical system. We formulate 3 recommendations to improve the inclusion of loved ones into the patient's hospital stay.

Conclusions

"Loved ones are not 'visitors' in a patient's life". Irrespective of COVID-19, patient's loved ones need to be included during the patient's hospital journey. Transparent communication and patient empowerment increase patient safety and improve the hospital experience for both the patients and their loved ones. Our findings underline the need for the concept of family-centered care to finally be implemented in adult nursing clinical practice.

Impact of #PsychTwitter in promoting global psychiatry: A hashtag analysis study

Introduction

Multiple studies have shown how valuable Twitter hashtags can be for promoting content related to different themes in the online community. This arena has grown into a rich data source for public health observation and understanding key trends in healthcare on a global scale. In the field of mental health in particular, it would be of benefit to understand and report the key stakeholders' (individual mental health professionals, academic organizations and their countries) trends and patterns of psychiatric knowledge and information dissemination using #PsychTwitter.

Objective

In this study, we aim to evaluate the achieved outreach of psychiatry-related tweets using the hashtag #PsychTwitter.

Methods

We utilized the Symplur Signals research analytics tool to characterize tweets containing #PsychTwitter from the 20th of August, 2019, to the 20th of August, 2022.

Results

The #PsychTwitter movement resulted in 125,297 tweets that were shared by 40,058 Twitter users and generated a total of 492,565,230 impressions (views). The three largest identified groups of contributors were Doctors (13.8% of all tweets), Org. Advocacy (6.2% of all tweets), and Researcher/Academic (4% of all tweets) stakeholders. The top influential accounts consisted of 55 psychiatrists and 16 institutional or organizational accounts. The top 5 countries from where most of the tweets containing #PsychTwitter were shared include the United States (54.3% of all users), the United Kingdom (10.4% of all users), Canada (4.9% of all users), India (2% of all users), and Australia (1.8% of all users).

Conclusion

This is the first of its kind study featuring the influence and usage of #PsychTwitter and covering its global impact in the field of psychiatry using the Twitter platform. Our results indicate that Twitter represents a broadly used platform for mental health-related discussions.

The Fractal Viewpoint of Tumors and Nanoparticles

Even though the promising therapies against cancer are rapidly improved, the oncology patients population has seen exponential growth, placing cancer in 5th place among the ten deadliest diseases. Efficient drug delivery systems must overcome multiple barriers and maximize drug delivery to the target tumors, simultaneously limiting side effects. Since the first observation of the quantum tunneling phenomenon, many multidisciplinary studies have offered quantum-inspired solutions to optimized tumor mapping and efficient nanodrug design. The property of a wave function to propagate through a potential barrier offer the capability of obtaining 3D surface profiles using imaging of individual atoms on the surface of a material. The application of quantum tunneling on a scanning tunneling microscope offers an exact surface roughness mapping of tumors and pharmaceutical particles. Critical elements to cancer nanotherapeutics apply the fractal theory and calculate the fractal dimension for efficient tumor surface imaging at the atomic level. This review study presents the latest biological approaches to cancer management based on fractal geometry.

Clinical presentation of peritoneal tuberculosis

Peritoneal tuberculosis arises from hematogenous spread of pulmonary foci or from direct spread from an adjacent structure. Diagnosis of peritoneal tuberculosis can be challenging due to nonspecific symptoms, insidious onset, and variable imaging findings. Herein, we report a patient presenting with ascites who was eventually diagnosed with peritoneal tuberculosis.

The International Natural Product Sciences Taskforce (INPST) and the power of Twitter networking exemplified through #INPST hashtag analysis

BACKGROUND

The development of digital technologies and the evolution of open innovation approaches have enabled the creation of diverse virtual organizations and enterprises coordinating their activities primarily online. The open innovation platform titled "International Natural Product Sciences Taskforce" (INPST) was established in 2018, to bring together in collaborative environment individuals and organizations interested in natural product scientific research, and to empower their interactions by using digital communication tools.

METHODS

In this work, we present a general overview of INPST activities and showcase the specific use of Twitter as a powerful networking tool that was used to host a one-week "2021 INPST Twitter Networking Event" (spanning from 31st May 2021 to 6th June 2021) based on the application of the Twitter hashtag #INPST.

RESULTS AND CONCLUSION

The use of this hashtag during the networking event period was analyzed with Symplur Signals (https://www.symplur.com/), revealing a total of 6,036 tweets, shared by 686 users, which generated a total of 65,004,773 impressions (views of the respective tweets). This networking event's achieved high visibility and participation rate showcases a convincing example of how this social media platform can be used as a highly effective tool to host virtual Twitter-based international biomedical research events.

Low coverage of COVID-19 vaccines in Africa: current evidence and the way forward

Disparities in COVID-19 vaccine coverage across the globe have uncovered inequities in global healthcare. While more than half of the population of the developed countries have been fully vaccinated, only a small percentage of the African population has received one vaccine dose so far, a far cry from the global vaccination targets. Furthermore, several low and middle income (LMICs) African countries lack the competence, infrastructure, logistics, and financial resources to mass-vaccinate their populations. This paper highlights the causes and implications of the low COVID-19 vaccine coverage on Africa and the global community, and discusses strategies for restructuring and strengthening COVID-19 vaccination in Africa.

The role of nanomaterials in enhancing natural product translational potential and modulating endoplasmic reticulum stress in the treatment of ovarian cancer

Ovarian cancer, and particularly its most frequent type, epithelial ovarian carcinoma, constitutes one of the most dangerous malignant tumors among females. Substantial evidence has described the potential of phytochemicals against ovarian cancer. The effect of natural compounds on endoplasmic reticulum (ER) stress is of great relevance in this regard. In ovarian cancer, the accumulation of misfolded proteins in the ER lumen results in decompensated ER stress. This leads to deregulation in the physiological processes for the posttranslational modification of proteins, jeopardizes cellular homeostasis, and increases apoptotic signaling. Several metabolites and metabolite extracts of phytochemical origin have been studied in the context of ER stress in ovarian cancer. Resveratrol, quercetin, curcumin, fucosterol, cleistopholine, fucoidan, and epicatechin gallate, among others, have shown inhibitory potential against ER stress. The chemical structure of each compound plays an important role concerning its pharmacodynamics, pharmacokinetics, and overall effectiveness. Studying and cross-comparing the chemical features that render different phytochemicals effective in eliciting particular anti-ER stress actions can help improve drug design or develop multipotent combination regimens. Many studies have also investigated the properties of formulations such as nanoparticles, niosomes, liposomes, and intravenous hydrogel based on curcumin and quercetin along with some other phytomolecules in ovarian cancer. Overall, the potential of phytochemicals in targeting genetic mechanisms of ovarian cancer warrants further translational and clinical investigation.

Risk of arterial thromboembolism in patients with concomitant atrial fibrillation and cancer: a systematic review and meta-analysis

Background/Introduction

Atrial fibrillation (AF) and cancer often co-exist and have been independently associated with increased risk of arterial thromboembolism (TE), all cause death and bleeding; however, no cumulative data exist regarding the clinical course of AF patients with comorbid cancer.

Purpose

The aim of this systematic review and meta-analysis is to synthesize the available data regarding the incidence of major adverse cardiovascular events in AF patients in association with concurrent cancer.

Methods

The composite outcome of any TE (ischemic stroke, transient ischemic attack, or arterial thrombosis) was defined as the primary study outcome, while all-cause mortality and major or clinically relevant non-major bleeding occurrence as the secondary ones. Literature search was conducted in PubMed (MEDLINE), WebOfScience, Scopus, CENTRAL, OpenGrey, and EThOS databases. A random-effects model meta-analysis was performed. Subgroup analyses were conducted assessing the effect of active cancer history and various cancer subtypes on the outcomes of interest. Meta-regression analyses were also performed to examine the relative impact of CHA2DS2VASC and HASBLED prognostic scores on the risk of TE and bleeding, respectively.

Results

Overall 17 studies were included in our analysis, encompassing a total of 3,151,861 AF patients. Comorbid cancer was non-significantly associated with lower odds of TE than AF alone (pooled odds ratio (pOR) = 0.85, 95% confidence interval (CI): 0.69–1.03, I2=87%). The likelihood for all-cause death and bleeding occurrence was significantly higher in AF patients with cancer (pOR = 2.27, 95% CI: 1.69–3.06, I2=99%); pOR = 1.58, 95% CI: 1.26–1.97, I2=97% respectively) compared to those without cancer. Subgroup analysis on active cancer status did not yield any substantial difference, marginally improving the heterogeneity of our analysis. The highest all-cause mortality likelihood was observed in Liver-Pancreas-Gallbladder category (pOR = 10.58, 95% CI: 4.69–23.88, I2=98%) while the highest bleeding likelihood was encountered in Genitourinary cancer (pOR = 1.90, 95% CI: 1.42–2.55, I2=71.9%). The performed meta-regression analyses did not yield any significant results.

Conclusions

Our meta-analysis of 17 eligible studies demonstrated that cancer does not seem to be associated with increased risk of TE, while with increased all-cause death and bleeding occurrence in AF patients. This correlation might be explained by higher cancer-driven mortality rates (competing risk), many cases of TE being left undiagnosed within the scope of palliative cancer care, misdiagnosed episodes of TE due to the presence of brain metastases, optimal cardio-oncology monitoring, and more frequent usage of prophylactic anticoagulation treatment for cancer-associated venous thromboembolism. Nonetheless, further competing-risk survival analyses are warranted before reaching definite conclusions.

Funding Acknowledgement

Type of funding sources: None.

The war in Ukraine and diabetic foot care: Challenges, recommendations

AIMS

A number of reports have illustrated the barriers that the war in Ukraine puts to diabetes care. While their recommendations are valuable for glycemic control and the prevention or early detection of life - threatening diabetes complications, such as hypoglycemia and ketoacidosis, the discourse on diabetic foot is limited. This letter emphasizes the implications of the war in diabetic foot care and discusses potential solutions.

METHODS

The authors searched peer - reviewed and grey literature to identify records related to the prevalence of diabetic foot in Ukraine and the standards of care before and after the invasion of Ukraine.

RESULTS

Thousands of people in Ukraine sustain diabetic foot ulcers and, thus, are at high risk for lower limb amputations due to the limited access to healthcare services in the country. If not addressed, disability associated with chronic ulcers and amputations can severely affect individual and public health in Ukraine. Strengthening primary and remote care, educating people on self - care and providing adequate supplies for the management of diabetic foot have a major potential to prevent amputations, disability and death.

CONCLUSIONS

Providing adequate diabetic foot care in Ukraine and other regions tormented by armed conflicts is vital for the health of the local population and the potential of the affected countries to recover after the crisis.

To pollute or not to pollute? Decreasing the ecological footprint of pediatrics in the COVID-19 era

The climate crisis impacts child health, increasing the burden of pediatric healthcare. During the COVID-19 pandemic, the ecological footprint of pediatric healthcare has significantly increased due to the use of personal protective equipment and the provision of large-scale testing and vaccination against COVID-19. The situation calls for coordinated action to make pediatric healthcare more resource-efficient. To achieve this goal, pediatricians should work together with children and parents in order to appropriately minimize the use of electricity, water, paper and plastic and promote environmental sustainability in healthcare and beyond. The present article discusses the main sources of environmental pollution in pediatric healthcare and proposes evidence-based solutions.

Cytokine storm and neuropathological alterations in patients with neurological manifestations of COVID-19

The COVID-19 pandemic is caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2), a respiratory pathogen with neuroinvasive potential. Neurological COVID-19 manifestations include loss of smell and taste, headache, dizziness, stroke, and potentially fatal encephalitis. Several studies found elevated proinflammatory cytokines such as TNF-α, IFN-γ, IL-6 IL-8, IL-10 IL-16, IL-17A, and IL-18 in severely and critically ill COVID-19 patients, which may persist even after apparent recovery from infection. Biomarker studies on CSF and plasma and serum from COVID-19 patients have also shown a high level of IL-6, intrathecal IgG, neurofilament light chain (NFL), glial fibrillary acidic protein (GFAP), and tau protein. Emerging evidence on the matter has established the concept of COVID-19 associated neuroinflammation, in the context of COVID-19 associated cytokine storm. While the short-term implications of this condition are extensively documented, its long-term implications are yet to be understood. The association of the aforementioned cytokines with the pathogenesis of neurodegenerative diseases, including Alzheimer's disease, Parkinson's disease, Huntington disease, and amyotrophic lateral sclerosis, may increase COVID-19 patients' risk to develop neurodegenerative diseases. Analysis of proinflammatory cytokines and CSF biomarkers in patients with COVID-19 can contribute to the early detection of the disease's exacerbation, monitoring the neurological implications of the disease and devising risk scales, and identifying treatment targets.