The Not So Obvious Impact of COVID 19: The Hidden “Curriculum”

The last two years of the Covid 19 pandemic has certainly brought on and inculcated a variety of changes, new practices, innovative approaches and altered mindsets. Some of these were intended, planned and incorporated into pathways and practices. There were many lessons and new experiences. Without our complete realization, there were also many less obvious lessons: the hidden curriculum. This refers to the unwritten, unspoken, unplanned and less obvious values, behaviour and norms practised or experienced during the pandemic. The hidden curriculum is conveyed and communicated without our direct awareness and intent. The hidden curriculum will certainly contribute towards healthcare staff resilience, handling of stressors, decisions on utilization of resources and patient care. Not to be forgotten, it will also impact how they develop friendships, partnerships, collaborations, negotiate their self-development and strengthen their sense of purpose and challenge assumptions. In this paper, the author, who worked at the frontline during the pandemic shares some of her views on the new healthcare landscape, mindset changes, technology adoption, psychological safety and the meaning of ‘staying home’. They represent her views, coloured by her experiences as an emergency physician, a medical educator, academic medicine practitioner and researcher.

Precocious Puberty: Causes, Consequences, Daily Environmental Factors, and the need for Community/Societal Support

Precocious puberty, otherwise described as a group of medical conditions that cause early puberty onset, such as a pre-adolescent boy presenting with adult pattern of penile and testicular enlargement or a pre-adolescent girl presenting with mature breast development and onset of menses. Although the sexual and physical characteristics for this condition are well-described in medical literature, the causes are very rarely known. Nevertheless, it has substantial impacts on children’s lives. This is a review on sexual development, premature sexual development, the social complications children suffer from due to early onset puberty, and the associations with daily environmental exposures as possible influences for developing precocious puberty.

Ancient Audacity---Did Sages Past Subconsciously Speak Of Cellular Dust?

“Would it be too bold to imagine, that in the great length of time, since the earth began to exist, perhaps millions of ages before the commencement of the history of mankind, would it be too bold to imagine, that all warm-blooded animals have arisen from one living filament, which THE GREAT FIRST CAUSE endued with animality, with the power of acquiring new parts, attended with new propensities, directed by irritations, sensations, volitions, and associations; and thus possessing the faculty of continuing to improve by its own inherent activity, and of delivering down those improvements by generation to its posterity, world without end!

Routes of Infections, Inflammation, Immunity, Immunity Response and Inflammatory Injury: Elucidation of a Biological Fight

Infections, inflammation, immunity, and inflammatory injury are different segments of biological events and link up altogether. Route of infection has no similarity with the cellular signaling pathway of inflammation, even though when inflammation is induced by infection. The organism responds toward infection that is initiated by the pathogen via inflammation, which is a natural way of defense initiated by innate immunity as a safeguard

Re-Print-Anaphylaxis Induced by Beer

The prevalence of cereal allergy is highly influenced by geographical area and consumption habits. According to data from Alergologica 2015 [1], cereal allergy accounts for 2.1% of all cases of food allergy in Spain. Beer is a barley-based alcoholic beverage that also contains hops, yeast, and other cereals (wheat, oats, corn, and even rye). Barley is also the basis of malt vinegar, whiskey, and gin. Several allergens of barley have been described, including lipid transfer protein (LTP), - and ß-amylase, gliadin, glutenin, peroxiredoxin, thionin, and trypsin inhibitor [2].

Re-Print- Artificial Respiration in Severe COVID-19 Cases: A Beneficial or Deleterious Treatment

The world over artificial respiration is employed as one of the intensive care treatment measures in severe cases of COVID-19 because of the significant respiratory distress patients develop. Nevertheless, the outcome is poor. Lethality varies from country to country and clinic to clinic between 50% and 90%. So the question arises as to whether the use of oxygen can be a risk factor in the treatment of acute inflammatory diseases in general and of COVID-19 in particular. Oxidative stress is the first and oldest step of cellular defense and starts before the activation of the immune system. This leads to an increase of intracellular oxygen in the mitochondria, followed by an elevated electron flow and the formation of superoxide as well as other reactive oxygen species and reactive nitrogen species. Superoxide reacts with nitric oxide, which is always present in inflammation, forming peroxynitrite, the strongest inducer of oxidative stress. This step induces the activation of nuclear factor kB, followed by the production of proinflammatory cytokines. The elevated levels of inducible nitric oxide synthase keep this cycle running. High amounts of superoxide have to be compensated and catabolized by manganese-superoxide dismutase 2 into hydrogen peroxide and in a second step by catalase into water. When using artificial respiration, these steps are accelerated considerably in the inflamed tissue of the lung, leading to a significant increase of the electron flow as well as an elevation of superoxide, oxidative stress, and water. As SARS-CoV-2 generally induces the production of proteins (and not only those necessary for viral reproduction), the water will remain in the tissue, causing edema and thus a wet lung syndrome associated with a growing oxygen diffusion distance to red blood cells. Ultimately, patients do not suffocate in spite of, but because of, the presence of high levels of oxygen. The limited number of patients who survive this deleterious treatment describe it as having had a sensation of drowning. The reasons will be discussed.

Evaluation of Mutagenicity of Covid-19 Virus and the effect of Morphine in its Treatment

Because the covid-19 virus is amazingly mutating, we urgently need a lot of articles in this area. In light of recent events, we have been writing an article on the mutagenicity of the covid-19 virus and treatment with morphine. The covid-19 virus is an exception due to its non-segmented genome, its mutagenicity. Also in this article morphine is a suitable drug because it neutralizes most of the symptoms of the covid-19 virus. Morphine increases immunity against the virus due to the presence of mu3 receptors on the surface of immune cells. Morphine also counteracts symptoms such as shortness of breath, pain, and even diarrhea. Diarrhea has been reported in cases of the covid-19 virus.

Intestine epithelial cell-Derived Extracellular Vesicles alleviate Inflammation Induced by Clostridioides Difficile TcdB through the Activity of TGF- β1

Background: Clostridioides difficile infection (CDI) has been primarily associated with the toxin B (TcdB), which can activate the intestinal immune system and lead to pathological damage. Even though the biological functions of intestine epithelial cell- derived extracellular vesicles (I-Evs) have been well documented, the role of I-Evs in the process of CDI is still unknown. Results: We isolated I-Evs ranging from 100–200 nm in mean diameter, with a density of 1.09-1.17 g/mL. These I-Evs expressed the extracellular vesicle-associated specific surface markers, CD63 and TSG101. In vitro, 50 µg I-Evs decreased the expression of IL-6, TNF- β, IL-1β, and IL-22 in MC38 induced by 0.8 ng/mL C. difficile TcdB, and increased expression of TGF- β1. In vivo, I-Evs also promoted regulatory T cell induction, which improved inflammation of mice up to 80% relative to C. difficile TcdB infected mice, depending on the TGF- β1 signal pathway. Conclusion: Our study firstly demonstrated that I-Evs originated from intestine epithelial cells is potentially a novel treatment endogenous candidate to effectively reduce the local infection induced by C. difficile TcdB.

Does Immunomodulation Therapy of Sepsis Refer Directly to Tumor Immunotherapy?

Sepsis remains a major cause of mortality in critical care, and the failures of highly touted trials have caused experts to call for re-evaluation of the approach toward sepsis

Immune Reconstitution Inflammatory Syndrome During the First Six Months of Receiving Antiretroviral in HIV-Infected Individuals: A Retrospective Cohort Study

Introduction: Immune reconstitution inflammatory syndrome (IRIS) is referred to as the flare up of an underlying, previously undiagnosed infection or the worsening of a previously treated infection soon after antiretroviral therapy (ART) is started. Information about the prevalence and associated risk factors for IRIS in resource-constrained countries like Tanzania where access to ART is increasing is scarce. Therefore, this study was conducted to determine the prevalence and risk factors associated with IRIS among patients attending care and treatment clinic at Muhimbili National Hospital (CTC-MNH). Methods: A retrospective cohort study was conducted in patients receiving highly active antiretroviral therapy (HAART) who attended CTC-MNH between July 2016 and June 2018. Mann Whitney test was used to compare median CD4+ cells count and viral load at baseline and after 6 months of treatment. Associated factors were analysed using multi-logistic regression. Statistics were done using GraphPad Prism 7 software and a p-value < 0.05 was considered statistically significant. Results: Of 318 patients, 8.5% encountered IRIS. Compared to baseline readings, there were significant increases in CD4+ cells (P < 0.0001) and decrease in viral load count (P < 0.0001). Patients who did not adhere to HAART were more likely to develop IRIS [Adjusted Odds Ratio (AOR) = 4.2, 95% CI; 1.14-15.60, P = 0.03]. Conclusion: This study found relatively low prevalence of IRIS as compared to those reported elsewhere. Moreover, poor adherence to HAART was found to be a risk factor for IRIS.