Reconstruction surgery in head and neck cancer patients amidst the COVID-19 pandemic:Current practice and lessons for the future

The coronavirus disease 2019(COVID-19)pandemic has imposed a radical change in daily life and work routine.In this context,health systems have suffered important and serious repercussions in all fields.Among the changes brought about by the state of global health emergency,adjustments to guidelines,priorities,structures,professional teams,and epidemiological data stand out.In light of this,the oncological field has witnessed several changes in the approach to cancer,whether due to delay in diagnosis,screening deficit,personnel shortage or the psychological impact that the pandemic has had on cancer patients.This article focuses on the management of oral carcinoma and the surgical approaches that oral and maxillofacial specialists have had at their disposal during the health emergency.In this period,the oral and maxillofacial surgeons have faced many obstacles.The proximity of maxillofacial structures to the airways,the need of elective and punctual procedures in cancerous lesions,the aggressiveness of head and neck tumors,and the need for important healthcare costs to support such delicate surgeries are examples of some of the challenges imposed for this field.One of the possible surgical'solutions'to the difficulties in managing surgical cases of oral carcinoma during the pandemic is locoregional flaps,which in the pre-COVID-19 era were less used than free flaps.However,during the health emergency,its use has been widely reassessed.This setback may represent a precedent for opening up new reflections.In the course of a long-term pandemic,a reassessment of the validity of different medical and surgical therapeutic approaches should be considered.Finally,given that the pandemic has highlighted vulnerabilities and shortcomings in a number of ways,including the issues of essential resource shortages,underinvestment in public health services,lack of coordination and versatility among politicians,policymakers and health leaders,resulting in overloaded health systems,rapid case development,and high mortality,a more careful analysis of the changes needed in different health systems to satisfactorily face future emergencies is essential to be carried out.This should be directed especially towards improving the management of health systems,their coordination as well as reviewing related practices,even in the surgical field.

Immunogenicity, Safety and Efficacy Comparison of Wockhardt’s Biosimilar Insulin Glargine—Glaritus®with Reference Product— Lantus®: Study Protocol &Early Data Trends

Objective: Present Phase IV Trial is aimed at evaluating the immunogenicity, safety, and efficacy of Wockhardt’s insulin glargine, Glaritus®in comparison with reference insulin glargine, Lantus®in subjects with type 2 diabetes mellitus (T2DM), inadequately controlled on oral hypoglycaemics. Setting: A head-to-head, prospective, open-label, parallel group, randomized, Phase IV, non-inferiority study over 6 months treatment conducted in 10 centres in India. Participants: Considering 20% drop-out rate, 180 subjects of either sex, age 18 - 55 years, diagnosed with T2DM with body mass index (BMI) 18 - 38 kg/m2 and HbA1c levels 8.0% - 10.0% inadequately controlled by 1 or more oral hypoglycaemics and according to investigator needed glargine treatment were enrolled in the study. Interventions: Subjects self-administered insulin glargine (Glaritus®or Lantus®) subcutaneously once daily for 6 months. Treatment in Glaritus®arm was continued till 12 months. Percentage change in anti-insulin antibody (AIA) titre and HbA1C was ascertained at every 3 months interval. The tests were performed at accredited central laboratory. Treat-to-target dose titration: Starting doses of Glaritus®and Lantus®was 10 units (or 0.2 units/kg) once daily. The target fasting blood glucose was 70 to 130 mg/dL. Daily glargine dose was titrated by ±10% based on average of last 3 FBG values being out of target range and presence of nocturnal hypoglycemia. Early data trends: First interim analysis was planned once 100 subjects complete visit 8 (6 months treatment). By then, 119 subjects (78 males and 41 females) with mean age 46.3 years were enrolled, of which 90 (75.6%) subjects had evaluable data. The results of analysis indicated trend of comparability between Glaritus®and Lantus®at the end of 6 months in terms of immunogenicity (% change in AIA titre from baseline, −10.52 ± 23.06 vs. 0.48 ± 63.95), glycemic control (change in HbA1c from baseline, −1.09% ± 1.29% vs. 0.63% ± 1.19%) and hypoglycemic events (reported by 1 vs. 2 patients), respectively. Conclusion: The present study represents a robust design in line with international guidelines on biosimilar insulin development and the early data trends presents expected similarity of Glaritus®in immunogenicity, efficacy and safety to that of Lantus®in treatment of T2DM.

Operating room black box:Scrutinizer of theatre practices

Objective:Adverse surgical events are a major cause of morbidity,mortality,and disability worldw ide.The cause of many such events can be attributed to interruptions in the operating room(OR),muli-tasking by surgeons,etc.The objective of this study was to observe the types and frequency of intra-operative wor kflow interruptions in our ORs.Method:This ccoss-sectional study was conducted from March Do April of 2023.An observational approach using an audio-video recording device was employed to record OR flow disr uptions.One elective OR and one emergency OR under the Department of General Surgery were selected for the study.All open and laparoscopic surger ies conducted in the selected ORs were included.An Internet Protocol camera'was installed in the selec ted ORS with a view of the entire room,including the anesthesia station.Audio-video recording was started after the first indsion and stopped after closure of the surgical site.Result:Of the 51 cases that were studied,45(88.2%)were elective,and 18(35.3%)were laparoscopic cases.They could be classified into 8 types of open procedures and 4 types of lapar oscopic procedures.The mean maximum headcount inside the OR was 15.5土3.6 and doors opened on average of 15.8土6.0 times during a procedure.Other interruptions were surgeons attending phone calls(24,47.1%),leaving the sterile area(21,41.2%),technical disturbances(32,62.7%),anesthetic interruptions(18,35.3%),and faulty instruments(29,56.9%)Elective procedures had a signifcandy higher average number of in-terruptions per operating hour than emergency procedures(175±8.6vs.7.1±2.9,p<0.01).Condusion:Preventable factors such as faulty instruments,anesthetic interruption,and attending phone calls by the surgeon are commonly observed in ORs.They need to be addressed by timely surgical audits or the adoption of continued sureillance methods that can help take measures to minimize their occurrence.

Future of mental health in the metaverse

The metaverse and non-fungible tokens(NFTs)were some of the hottest tech terms in 2021,according to a Google Trends search.Our review aims to describe the metaverse and NFTs in the context of their potential application in the treatment of mental health disorders.Advancements in technology have been changing human lives at an ever-increasing pace.Metaverse,also known as the threedimensional(3D)internet,is the convergence of virtual reality(VR)and physical reality in a digital space.It could potentially change the internet as we know it,with NFTs as the key building blocks in the new expansive virtual ecosystem.This immersive 3D virtual world boasts the features of the real world with the added ability to change the surrounding environment according to individual needs and requirements.VR,augmented reality(AR)and mixed reality(MR)have been employed as tools in the treatment of various mental health disorders for the past decade.Studies have reported positive results on their effectiveness in the diagnosis and treatment of mental health disorders.VR/AR/MR have been hailed as a solution to the acute shortage of mental health professionals and the lack of access to mental healthcare.But,on the flip side,young adults tend to spend a significant amount of time playing 3D immersive games and using social media,which can lead to insecurity,anxiety,depression,and behavioural addiction.Additionally,endless scrolling through social media platforms negatively affects individuals'attention span as well as aggravating the symptoms of adolescents with attention deficit hyperactivity disorder.We aimed to explore the ramifications of expanding applications of the metaverse on mental health.So far,no other review has explored the future of mental health in the context of the metaverse.

Efficacy of autologous platelet-rich plasma in the treatment of chronic nonhealing leg ulcers

Aim:The aim was to evaluate the efficacy of platelet-rich plasma(PRP)in the treatment of chronic nonhealing ulcers.Methods:A nonrandomized,uncontrolled study was performed on 24 patients with 33 nonhealing ulcers of various etiologies.All patients were treated with PRP at weekly intervals for a maximum of 6 treatments.At the end of the 6-week period,reduction in size of the ulcers(area and volume)was assessed.Results:The mean age of the patients was 42.5 years(standard deviation[SD]12.48).Of 33 ulcers,there were 19 venous ulcers,7 traumatic ulcers,2 ulcers secondary to pyoderma gangrenosum,2 diabetic ulcers,2 trophic ulcers,and 1 vasculitic ulcer.The mean duration of healing of the ulcers was 5.6 weeks(SD 3.23).The mean percentage of reduction in area and volume of the ulcers was 91.7%(SD 18.4%)and 95%(SD 14%),respectively.About 100%resolution in the area was seen in 25(76%)of the ulcers and 100%reduction in volume was seen in 24(73%)of the ulcers at the end of the 6th treatment.Conclusion:Conventional therapies do not provide satisfactory healing for chronic nonhealing ulcers as they are not able to provide the necessary growth factors(GFs)(platelet-derived GF,epidermal GF,vascular endothelial GF,etc.)which are essential for the healing process.PRP is a safe,affordable,biocompatible,and simple office-based procedure for the treatment of nonhealing ulcers.