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- The Missing Link At Anesthesia Induction: Excessive Dynamic Airway Collapse
My opinion: As an anesthesia provider, it has always bewildered me that despite visual confirmation of endotracheal tube’s passage across the vocal cords on video-laryngoscopy, capnography confirmation on the anesthesia monitor is sometimes delayed by few-to-many breaths. This delayed appearance of end-tidal carbon dioxide can b..
- "It's poverty, Covid"
My opinion: In 1990s, James Carville said that it is all about economy whichever way one looks at it [1]. Essentially, economy has evolved as a guise for food energy because food energy for individual’s survival requires individual’s society’s economic growth. Now the question arises whether food energy availability is modif..
- Idiopathic Postoperative Paresis: Know The Unknown
Case Report(s): Postoperative paresis can be frustrating when aetiology is unclear. Herein, after obtaining written and informed consents, we are presenting perioperative hospital course of two patients with “idiopathic” postoperative paresis. Case One: 31-year-old multigravida female presented to labour and delivery suite in ac..
- Investigate In-Mask Temperature As A Surrogate Indicator Of Potentially "Therapeutic" Nasopharyngeal Temperature Denoting Masks' Therapeutic Efficiency To Complement Masks' Filtration Efficiency Against SARS-CoV-2 And Its Variants
My opinion: Abundance of information leading to abundance of interpretation leads to abundance of misunderstanding thus creating a double jeopardy preventing the true understanding of information. Herein, I am sharing my interpretation hoping to correct the misunderstanding unless my understanding of the ever-changing situation ma..
- My In-Mask Micro-Climate's Hot And Humid Efficiency
My opinion: Since the dawn of COVID-19 pandemic, I have been personally exploring my masks’ ambiance. After documenting in-mask heat and humidity objectively determined with Hygrochron iButton DS1923 in my face covering [1], I had been wondering whether my in-mask micro-climate will differ (A) if simple mask vs. valved mask vs. ..
- The Effects of Wet Cupping on White Blood Cells Count: A Retrospective Study
Introduction: Background: Wet cupping is the process of using a vacuum at different points on the body but with incisions in order to remove 'harmful' blood, which lies just beneath the surface of the skin. Cupping can be used on the neck, shoulders, back, sacral area, hip, abdomen, thigh, upper arms, and calves 1. Although there ..
- Triple negative breast cancer under neoadjuvant treatment: the role of assessment ultrasound.
Abstract : Triple-negative breast cancer is a separate entity that comprises several molecular subtypes driven by specific genetic alterations that might potentially be targeted. However, currently most patients continue to receive standard chemotherapy regimens. Neoadjuvant treatment is accepted for larger tumours and locally ad..
- Can Audiometry/Tympanometry Unravel If Our Masks Not Allowing Our Ear Drums To Vibrate Freely?
My Opinion: It happens to be a chance real observation and a chance theoretical interpretation. It is just an amusing tell-tale that what people are saying and what we are hearing is not exactly the same when they or we especially when they and we are wearing masks. So, the question arises how the masks are affecting our hearing [..
- Does Pre-Extubation Nasal Air Flow Attenuate Emergence Delirium Among Pediatric Surgical Patients? A Worth Exploring Envisaged Randomized Controlled Trial
Origin Of Hypothesis: The role of air flow across nasal passage and paranasal sinuses in relation to keeping the brain cool is often debated [1]. Similarly, the role of brain temperature in relation to cognition, sleep and delirium is also debated [2-4]. Therefore, anesthesiologists have a simple opportunity to explore, investigate and docu..
- Worth Investigating: Sunbathing (Sunfacial) With Masks On (SUMA) For Cleansing "Cold" Viruses
My Hypothesis: It is my opinion that as SARS-CoV-2 is mutating into new variants complicating the ongoing raging pandemic, it remains to be seen whether transmissibility of mutating viruses makes their virulence irrelevant when determining their pathogenic potential considering that globally human bodies have had already developed to..
- Questions Worth Raising: Automated Writing Evaluations And Legacy Admissions
My opinion: As medical education researchers, we have a vision and that is why we are raising these questions. Can automated writing evaluations of personal statement help in objective assessments of applications? Can legacy admissions be objectively streamlined in graduate medical education?..
- Tape Fixture Or Phone Holder To Stably Hold Probe For Continuous Transthoracic Echocardiography
My opinion: Analogous to old-school air-tight chest tube dressing, transthoracic echocardiography probe (wireless or portable or standard) can be fixed to the chest with silk or cloth tape as demonstrated on the mannequin (Figure A). This no-cost method had been originally envisaged by our team to potentially investigate and poten..
- Is Adversity Creating An Opportunity?
My opinion: Rather than being my opinion, the below-mentioned are just my questions. Are undesirable effects of labor epidural analgesia essentially due to it exposing materno-fetal homeostasis to exogenous substances during intra-partum period [1]? While the multidisciplinary medical society gears up to initiate research to valid..
- Does Being Child-Free While Dying-Mean To Eventually Eco-Decompose Preemptively Palliate The Climate Emergency?
My opinion: It is my opinion that the Climate Emergency as humanity’s precipice warrants resourceful adaptations in environmental activism by inventing public opinion rather than investigating public opinion if it wants to emulate the sweeping success of political conservatism globally [1-3]. We have always talked about preventi..
- Until Advancing Age Gets Reversed With A Pinch Of Salt, Usage Duration Of Mask Trinity As Universal Precaution Against Discrimination
My opinion: I am raising the following questions: Can omnipotent cells in young age sera overcome aging to reverse the advancing age which has turned out to be a major risk factor for COVID-19 related morbidity and mortality? Can salt-impregnated masks inactivating pathogens make a case for salt itself as an administration vehicle..
- Futuristic On-The-Job Fellowships
My opinion: My opinion has a backstory. I graduated from Anesthesiology Residency Program almost a decade ago. Initially, I pursued Pain Medicine Fellowship, but I did not succeed. Once I started my job, I abandoned my pursuit for fellowship. However, amidst the opioid epidemic, I considered pursuing Addiction Medicine Fellowship...
- Conscientious Objection to The Necessity of Unnecessary Healthcare Bubble
My opinion: Sommer et al. should be congratulated for exploring multifaceted effects on patients secondary to cancellations/postponements of interventions [1]. However, the follow-up question should have been: If non-emergency interventions’ completion had been necessary within a certain stipulated time frames, they might not ha..
- COVID-19 Pandemic: An Opportunity for Public Health Learning
My opinion: Coronavirus disease 19 (COVID-19) pandemic is indeed the most critical global incident for many decades. It has touched almost all humans, regardless of their race, gender, age, socioeconomic status or educational level (1). Although the influence of the pandemic on our lives was variable, nobody was protected. By the ..
- Diffusion of Innovation and Health Messages during COVID-19 pandemic : A South Africa case study
Abstract : Health messages are indispensable in public health; they are the connection between health experts, researchers and communities. The purpose of this case study is to assess the current health messages used to curb COVID-19 transmission in South Africa. The study also compared the SA health messages to best practices in..
- NOT Hate Masks; Just Investigate Them Regarding: Fungal Rhino-Sinusitis, Catabolic Myo-Arthralgia, Schoolchildren's Cognition, Sclerosis's Temperature And Disability Sabbatical
My opinion: Love and hate are powerful words which are often overused to make or break the case for what we love or what we hate. Personally, I have never loved masks even when they now seem “therapeutic” to me against pathogens like SARS-CoV-2 [1-2]. However, I cannot hate their non-physiological micro-environments [3] becaus..
- RECURRENT PULMONARY EMBOLISM IN METASTATIC BREAST CANCER: RESPONDING TO A DOSE REDUCTION OF ANTICANCER TREATMENT
Abstract: Venous thromboembolism (VTE) is a major complication in cancer patients despite anticoagulation. In fact this is the second cause of death in them, only behind the malignancy itself. Therefore, optimal treatment is crucial. Low-molecular-weight heparin (LMWH) and direct oral anticoagulants (DOACs) have been included as..
- Communicating COVID-19 prevention Health Messages: A case study of South Africa
Abstract : Abstract: Health messages are indispensable in public health; they are the connection between health experts, researchers and communities. The purpose of this case study is to assess the current health messages used to curb COVID-19 transmission in South Africa. The study also compared the SA health messages to best p..
- Can Bat-Gown, Bat-Sack, Bat-Box Protection Counter Bat-Human Contraption? An Envisaged Idea Triplet
Abstract: Dose of exposure cannot be downplayed whether it is the dose of inanimate chemicals, animate bacteria or viruses somewhere-in-between therein. Therefore, as high infectivity of clinical scenarios unravel during COVID-19 pandemic, Bat-Gown, Bat-Sack and Bat-Box as envisaged idea triplet may play a role to counter Bat-Hu..
- The Legend of Kalidasa Inspiring To Phase Out Overspecialization: Skills vs. Degrees
My opinion: There is a well-known legend about ancient Sanskrit scholar, Kalidasa. Before evolving into an acclaimed literary giant, he was supposedly a dimwit as depicted by him sawing the tree branch on which he was sitting [1]. However, there can be an alternate interpretation to the legend. Instead of sawing it, Kalidasa might..
- Non-Circumferential "Tourniquet" for Neck Vein Cannulation
My opinion: To engorge neck veins for cannulation, proceduralists (a) turn patients into Trendelenburg position and/or (b) ask patients to hold breath and/or (c) passively raise patients’ leg and/or (d) ask assistants to apply supraclavicular occlusive digital pressure just proximal to – towards heart – site of venous cannul..
- Artless solution to resolve the problem of retention in resorbed alveolar ridge cases
Abstract : Rarely maxillary completely edentulous ridges resorb to the extent where they pose a challenge to a prosthodontist. However, whenever they resorb, they definitely alter patient compliance towards dent..
- Can the Occlus-o-guide be used in mixed dentition as interceptive therapy of Class II? A literature review
Abstract : The Occlus-o-guide is an elastodontic Eruption Guide Appliance, which could achieve the ideal occlusion by exploiting the natural forces of growth to obtain harmonic occlusion in a balanced craniofacial context. This study is a literature review and was conducted in order to know if the Occlus-o-guide can be used as an..
- Can COVID-19 Pandemic Invent Redesigned Electric Microcars To Be Parked Inside Workplaces As Mask-Vacation Pods?
Abstract: Non-physiological in-mask microclimates may require mask-vacation pods as safe-spaces for workers to break away from masks during COVID-19 pandemic...
- N99 Neck Masks for Neck Breathers
My opinion: Neck breathers may have air movement across tracheoesophageal puncture/fistula or laryngopharynx during vocalization leading to aerosols exiting via nasopharynx and oropharynx [1]. Therefore, neck breathers wear facemasks during COVID-19 pandemic as depicted by masked mannequin (Figure 1: pink arrowheads). However, nec..
- Are There Fatalities Due To Delayed Statewide Mandatory Mask Use Orders?
My opinion: It is a Pandora’s Box which Yehya et al [1] and Auger et al [2] have opened in the midst of global pandemic because although SARS-CoV-2 as a pathogen knows and follows no boundaries, local, regional and national policies may have created non-scientific boundaries with fractured global response becoming an obstacle to..
- Our Antrum: Empty, Filled, Full
My opinion: Inability to quantify gastric fullness preoperatively can be very frustrating for anesthesiologists. This is especially more so while managing gastrointestinal endoscopies, firstly because gastrointestinal endoscopies are primarily performed under moderate sedation with unprotected airways, and secondly because endosco..
- Metastatic colon cancer: is rechallenging still an option beyond second line? A quick review.
Abstract : Metastatic colorectal cancer continues to be very frequent and although the improvements in its systemic treatment throughout the past decade have been noticeable, much needs still to be done. Patients’ survival has been prolonged with good quality of life, being still suitable for further treatment, thus further opt..
- Young Females and Cerebral Venous Thrombosis
Abstract : Cerebral venous thrombosis (CVT), is an under diagnosed condition for acute or slowly progressive neurological deficit. CVT has a wide spectrum of signs and symptoms, which may evolve suddenly or over the weeks. It is clinically challenging and mimics neurological conditions, such as: meningitis, encephalopathy, benign..
- Midline diastema and crowding correction with Invisalign lite: a case report
Abstract : The Clear Aligner can be used to correct tooth movement without involving extraction, surgery, and other adjunct orthopaedic appliances. Some forms of attachments are required with clear aligners to a..
- Scissor bite and crowding correction with clear aligners: case report
Abstract : Background: To describe an esthetic orthodontic treatment using aligners in an adult patient with crowding and dental scissor bite. A 21-year-old female patient with skeletal class I presented for ..
- Weekly aligner changes to correct anterior crossbite: a case report
Abstract : The aim of this paper is to present and debate the treatment of a unilateral crossbite using clear aligners (Invisalign) with weekly changes. The advantages of protected movement, due to the presence ..
- Anterior crossbite and crowding correction with a series of clear aligners: case report
Introduction: Nowadays, there is a growing demand for aesthetic treatment among both adolescents and adults. Indeed, a recent study estimated that 45% of adults are unhappy with their smile and that 20%of these hav..
- A brief history of some important medical tools: remembering the past
Abstract : Our current daily routine is so comfortable that we forget about the past. Nothing in medicine has been gained without effort and behind these routinary tools, there is a long history that most of us ignore. This article pretends to be a short review of the origins and evolution of three significant advances in medic..
- Anecdotes: Postoperative-Incentive-Spirometry, CSE-Introducer-Needle, Triangulated-LMA-Circuit-Support, Cuff-Pressure-Self-Deflating-Syringe, No-Injection-of-Air-Technique
Acknowledgements: The author is indebted to his teachers who all taught him about anesthesiology over the years especially Vitaly D. Soskin, MD, PhD and Elie J. Chidiac, MD...
- 2019 College Admissions Story And ERAS/NRMP/GME
My opinion: 2019 College Admissions Story is pertaining to Honest Services Fraud statute [1-2]. This federal statute safeguards the third party from the harms caused by transactions between two parties whereby the transactions have caused the recipient party to be non-compliant in its duty to provide honest services to the collate..
- Artificial Intelligence And Redundant Specialties
My opinion: Historically, traffic stops used to be operated by traffic cops [1]. Our quest to make commuting smoother and roads safer has allowed artificial intelligence (AI) to take over and turn traffic cops redundant [2]. Recently, our voluntary explorations into our past through genealogy have created a worldwide human genome ..
- Self-Healing Ceiling
My opinion: The prominent weightage accrued to letters of recommendation and personal statements make one wonder whether the standardized examination-adjudged meritocracy misses out on applicants’ assessment as whole persons. However, the origin of letters of recommendation and personal statements a century back may be speaking ..
- Therapeutic Video Games for Attention Deficit Hyperactivity Disorder (ADHD)
ADHD, Pharmaceuticals, and Videogames: Attention Deficit Hyperactivity Disorder Diagnosis rates of ADHD in children range from 3-11% compared to 4% in adults.1-3 Diagnosis of ADHD rose 42% from 2003–2004 to 2011–2012.2 In 2011, 3.5 million children were being treated with therapeutics as reported by their parents.2 Stimulant medications such as amphetam..
- FUTURISTICALLY ADAPTABLE MANAGEMENT OF SEDATION COUGH PROJECTILE
My opinion: Although cough projectile may be commoner in intubated patient with endotracheal tube being a narrower conduit,[1] non-intubated patient can also generate cough projectile through wider oropharynx. During elective colonoscopy under fluctuating moderate-to-deep sedation levels, profuse regurgitation with or without coug..
- Subtraction of Attraction for Saner Workplaces
Abstract: Occupational health practitioners may acknowledge attraction as natural and innate instinct but must regulate it when difficulty in separating personal and professional lives is endangering sanity and survival of modern workplaces...
- Call for Standalone Clear Anesthesia Screen Drape
My opinion: Someone once said that the best monitor for the anesthesia provider is the direct visualization of surgical field itself. Even though it can be considered an overstatement in the modern digitally monitored operating rooms, direct visualization of surgical field despite being so-called old school method does not lose it..
- A Bioelectric Model of Meridian Channels in Pain Control and Wound Healing with Noninvasive Rectangular Pulse Electric Current Stimulation (RPECS)
Abstract : Questions: What are the meridian channels? Where do they locate if they exist? How do they function to control pain or cure diseases? The answers are not fully clear or confirmed today to our best k..
- Scalp cooling use in breast cancer patients receiving neoadjuvant/adjuvant systemic chemotherapy in England
Abstract : Background Chemotherapy-induced alopecia is a distressing side-effect. Currently the use of scalp cooling has been encouraged but we do not really know the rate of compliance or success in routine practice. Methods We have carried out an audit in our centre to assess both, compliance and success in our patients diagnos..
- Add Jaw-Thrust To Evolve 2-Rescuers Hands-Only CPR
My opinion: Cardiocerebral resuscitation (CCR) as an evolved form of cardiopulmonary resuscitation (CPR) has been termed as Hands-Only CPR (HOCPR) for the lay rescuers.[1] iStan Adult Patient Simulator (CAE Healthcare, Saint-Laurent, Quebec, Canada) provides definitive evidence of “covert” pulmonary resuscitation happening dur..
- COST CONSENT
My opinion: In medicine, patients’ consent for their medical management has evolved as a core ethical principle. One question arises: How responsibly do the patients give consent for their medical management [1-2]? Then the question comes: How can the patients responsibly give consent when they are not fully aware of what costs ..
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