潜在的食品污染剂与之相关的健康危险

The potential toxicants in food are derived from natural or industrial sources. Compounds like lectins and glycoalkaloids that are toxic to man are naturally present in some vegetables like potatoes or legumes. A wide variety of marine toxins mostly produced by dinoflagellates occurring secondarily in molluscs and mussels are usually ingested by human beings causing poisoning. On the other hand, toxic compounds find their way into food during manufacture, storage, or transportation. These include largely the industrial contaminants, persistent organic pollutants (POP), pesticides, heavy metals, and toxins of fungal and bacterial origin. Further, toxic compounds like higher alcohols may be produced as byproducts during processing. Migration of compounds from packaging materials into packaged food like contamination with lead from solder in certain metal cans is well known. Additives (emulsifiers, preservatives, and antioxidants) could also influence the quality of foods. Solvent residues may find their way into food as a result of their use in extraction processes like the use of trichloroethylene and methylene chloride in decaffeination of coffee. In addition, poor hygiene, storage, and preparation may also lead to food contamination by various microbes and ova or cysts of nematodes. The problem of food contamination can be overcome to a great extent by regular surveillance and monitoring programmes and strict implementation of food and adulteration act. In the present review some of these aspects of food contamination have been discussed in detail.     

Scoring systems in the intensive care unit: A compendium

Severity scales are important adjuncts of treatment in the intensive care unit (ICU) in order to predict patient outcome, comparing quality-of-care and stratification for clinical trials. Even though disease severity scores are not the key elements of treatment, they are however, an essential part of improvement in clinical decisions and in identifying patients with unexpected outcomes. Prediction models do face many challenges, but, proper application of these models helps in decision making at the right time and in decreasing hospital cost. In fact, they have become a necessary tool to describe ICU populations and to explain differences in mortality. However, it is also important to note that the choice of the severity score scale, index, or model should accurately match the event, setting or application; as mis-application, of such systems can lead to wastage of time, increased cost, unwarranted extrapolations and poor science. This article provides a brief overview of ICU severity scales (along with their predicted death/survival rate calculations) developed over the last 3 decades including several of them which has been revised accordingly.     

SARS-CoV-2 Omicron and its current known unknowns: A narrative review

The emergence of the SARS-CoV-2 Omicron variant (B.1.1.529) has created great global distress. This variant of concern shows multiple sublineages, importantly B.1.1.529.1 (BA.1), BA.1 + R346K (BA.1.1), and B.1.1.529.2 (BA.2), each with unique properties. However, little is known about this new variant, specifically its sub-variants. A narrative review was conducted to summarise the latest findings on transmissibility, clinical manifestations, diagnosis, and efficacy of current vaccines and treatments. Omicron has shown two times higher transmission rates than Delta and above ten times more infectious than other variants over a similar period. With more than 30 mutations in the spike protein's receptor-binding domain, there is reduced detection by conventional RT-PCR and rapid antigen tests. Moreover, the two-dose vaccine effectiveness against Delta and Omicron variants was found to be approximately 21%, suggesting an urgent need for a booster dose to prevent the possibility of breakthrough infections. However, the current vaccines remain highly efficacious against severe disease, hospitalisation, and mortality. Japanese preliminary lab data elucidated that the Omicron sublineage BA.2 shows a higher illness severity than BA.1. To date, the clinical management of Omicron remains unchanged, except for monoclonal antibodies. Thus far, only Bebtelovimab could sufficiently treat all three sub-variants of Omicron. Further studies are warranted to understand the complexity of Omicron and its sub-variants. Such research is necessary to improve the management and prevention of Omicron infection.     

Challenges and solutions to superior chimeric antigen receptor-T design and deployment for B-cell lymphomas

Chimeric antigen receptor-T (CAR-T) therapies represent a major breakthrough in cancer medicine, given the ex vivo-based technology that harnesses the power of one's own immune system. These therapeutics have demonstrated remarkable success for relapsed/refractory B-cell lymphomas. Although more than a decade has passed since the initial introduction of CAR-T therapeutics for patients with leukaemia and lymphoma, there is still significant debate as to where CAR-T therapeutics fit into the management paradigm, as consensus guidelines are limited. Competing interventions deployed in subsequent lines of therapy for aggressive lymphoma include novel targeted agents, bispecific antibodies, and time-honoured stem cell transplant. In this focused review, we discuss the major obstacles to advancing the therapeutic reach for CAR-T products in early lines of therapy. Such barriers include antigen escape, “cold” tumour microenvironments, host inflammation and CAR-T cell exhaustion. We highlight solutions including point-of-care CAR-T manufacturing and early T lymphopheresis. We review the evidence basis for early CAR-T deployment for B-cell lymphomas in light of the recent Food and Drug Administration (FDA) approval of three first-in-class anti-CD3/CD20 bispecific antibodies—mosunetuzumab, epcoritamab and glofitamab. We propose practical recommendations for 2024.     

Strategies and techniques for percutaneous Veno-Arterial ECMO cannulation and decannulation in children

The paper describes the first-in-human use of a dedicated, self-expandable covered stent system (VB stent) for closure of sinus venosus defects.     

Biomechanical and Finite Element Analysis of Mandibular Vertical Ramus Marginal Resection Designs

This study aims to know the post-surgical Von Mises stress of the mandible after two different vertical ramus marginal resection designs, analyze the results, compare with stress pattern of normal adult mandible without simulation and infer regarding the better of the two. Three groups of 3D finite element models of human adult mandibles were created. Group I (control)—normal mandible. Group II: Mandible with a quadrilateral vertical ramus marginal resection simulated. Group III: Mandible with an arc shaped vertical ramus marginal resection simulated. Finite element analysis (FEA) models were subjected to a point load of 475 N over right and left first molars, along with masticatory loads of masseter, medial pterygoid, anterior belly of digastric and temporalis loads in varying combinations (with and without bilateral temporalis and without right temporalis). The models were analyzed to infer the overall Von Mises stress in (a) the mandible (b) the sigmoid notch (c) postero-inferior resection corners. Results of our present study provides scientific evidence for the common practice of using arc form for marginal resection of vertical ramus of mandible whenever executed. Scientific evidence behind the concept of marginal resection of horizontal ramus is available but only scanty biomechanical evidence using finite element method (FEM) is available behind the same when performed in the vertical ramus, as magnitude and direction of loads in this region vary when compared to the horizontal ramus. The results ratify that incorporating arc shaped design pattern and removal of ipsilateral temporalis load by removal of coronoid, an area prone to stress concentration on loading, significantly decreases the post surgical Von Mises stress and hence would reduce the progressive micro-damage of the mandible after marginal resections of the vertical ramus of mandible.