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- Is Pandemic Teaching Gut Biome Maybe Holding The Key With Us Carrying Our Answers In Our Gut?
My opinion: Just like global epidemiology of HIV had its onset among men having sex with men, global epidemiology of monkeypox is following the same onset. However, just as HIV did not limit itself to men having sex with men, monkeypox too may evolve a similar pattern. Therefore, the question arises as to why so. Is it the absence..
- LEADERS CALL OUT FOR DIGITAL SANITY
My opinion: While followers are forcing their leaders to change [1], leaders expect digital sanity from their followers. At the push of a button, we are now able to connect. We all as followers are guilty of misusing this ease in our leaders’ accessibility. We only realize our leaders' difficulties once we ourselves are bombarde..
- Time For Gut Biome Metagenomics During Annual Physicals And Screening Colonoscopies
My opinion: Eating habits evolve. Purging habits evolve. Sexual habits evolve. The question is never whether such evolution is physiological, pathological, or psychological because evolution is always natural. The only lingering question is regarding how to prepare and adapt according to habits as they evolve. The bottom line for ..
- Tracheostomy Tube Exchanger
My opinion: Cuffless tracheostomy tube in-situ may present challenges when presenting for elective or emergent surgery under deep sedation to general anesthesia with patient's inability to spontaneously protect airway or under minimal sedation to moderate sedation with patient's presumed ability to spontaneously protect airway [1..
- Audit of Paclitaxel induced Peripheral Neuropathy in Early Breast Cancer
Abstract : Paclitaxel induced peripheral neuropathy (PIPN) is predominantly sensory. It usually appears with higher cumulative doses (>1,400 mg/m2), being less frequent with weekly regimens or lower doses. Numbness, paresthesias and burning pain in a glove-and-stocking distribution, distal and symmetrical are the most frequen..
- Revisiting Skill Of Asleep Nasotracheal Intubation
My opinion: With the advent of video-laryngoscopy, numbers of fiberoptic intubation are dwindling and it is ironic that not so long ago, fiberoptic intubation had itself relegated blind nasotracheal intubation as a skill of the past [1-2]. However, despite the dwindling-to-absent numbers, the skill of the past may still have some ..
- Blemish To Banish The Food And Famish Beast Within For Good
My opinion: There are legends but it may be time to see what they truly are. Until it is biologically proven that snakes [1] acquire something by being near to paper money or golden treasures, the only thing one can decipher is that owners and hoarders of money or gold want to scare off beggars and stealers by keeping the myth of ..
- Compression-Ventilation Ratio Of 75:5 Per Minute Can Become 100:10 Per Minute From The Get-Go: Time To Mandate Continuous Quantitative Waveform Capnography During Cardiopulmonary Resuscitation As Bag-Valve-Mask Capnography May Allow Continuous Chest Compressions Without Pausing To Visualize Chest Rise
My opinion: When we as anesthesia providers can no longer imagine providing anesthesia and even sedation to our even emergently boarded surgical patients without continuous quantitative waveform capnography, it is ironic that American Heart Association is awaiting more evidence before it can universally mandate its recommendation ..
- Surgical Site Infections (SSIs): Can Clear Anesthesia Screen Drape Be Suppressing Self-Infection (SSI)?
My opinion: Since the onset of pandemic, it has been anecdotally observed that incidence of surgical site infections (SSIs) may be coming down [1-6]. One of the explanations thought to be underlying this presumed reduction in SSIs is sterner as well as more complete use of personal protective equipment (PPE) not only by providers ..
- What Comes First: Suction Or Intubation Just Like Suction Or Extubation
My opinion: Blind suctioning [1-2] of oral cavity and oropharynx prior to extubating endotracheal tube or supraglottic airway device is routinely recommended to prevent airways emerging from general anesthesia reacting in response to tracheal aspiration of oral and oropharyngeal contents accumulated there while endotracheal tube o..
- Zero-Sum Game between Marginalization of Privilege and Privilege of Marginalization
My opinion: There is a famous legend wherein in response to Emperor Akbar’s question to shorten a line without erasing it, his minister Birbal responded by making a larger line next to it [1]. Privilege like many other things in life follows the same pattern. One can only belittle it but can never discard it. Moreover, the story..
- Eternal Work-Kin-Me: Mentees Must Understand Mentors
My opinion: We talk about work-kin-me as a modern-day invention in response to our modern-day workaholism induced by our modern-day consumerism and our corresponding modern-day overconsumption [1-2]. However, whether deemed workaholics or engaged with work [3-4], modern-day workers like us may have to read between the lines writte..
- Pentagonization of Healthcare
My opinion: Healthcare used to be about physician-patient relationship. But then healthcare grew. Whether it grew because physicians might have wanted more or because patients might have needed more is another chicken or egg dilemma or paradox. Anyhow healthcare grew. With its growth came the conundrum how to manage it from going ..
- Mini-Thesis: Shakti The Bollywood Movie And ACEs The Childhood Adversity
My opinion: Ever since reading research about adverse childhood experiences (ACEs) [1], a Bollywood movie titled Shakti (1982) [2] has been revisited and re-experienced multiple times. Even though the movie deserves a full-thesis, this is the mini-thesis dedicated to it for exploring effects of ACEs to the T well before the world ..
- CAGED PARENTS RAVAGED CHILDREN: Time To Inquire About Technology Driven Workaholism While Scoring ACEs/BRFSS
My opinion: Among the eleven questions of Module 21 related to adverse childhood experiences (ACEs) in 2020 Behavioral Risk Factor Surveillance System (BRFSS) questionnaire by Centers for Disease Control and Prevention (CDC) [1], three questions are related to sexual transgression while two questions each are related to aggression..
- A Survey of Gestational Diabetes in Broken Hill
Abstract : Background Gestational diabetes (GDM) is a common health issue in Australia, affecting around 16% of pregnancies. It is a routine to screen all pregnant women with a test known as 75g OGTT. Interestingly, the incident rate of gestational diabetes was found to be relatively similar in terms of remoteness of the area. Th..
- A study on across knee external fixation in adults
Abstract: External fixation is a commonly performed orthopedic surgical intervention . Across knee external fixation is carried out for various indications related to bones , joints and soft tissues . We report our observations on 41 across knee external fixators applied on 39 patients studied over a period of 4 years ...
- A study on across knee external fixation in adults
Abstract: External fixation is a commonly performed orthopedic surgical intervention . Across knee external fixation is carried out for various indications related to bones , joints and soft tissues . We report our observations on 41 across knee external fixators applied on 39 patients studied over a period of 4 years ...
- A Syndromic Approach to the B.1.1.529, 20K (Omicron) Variant Driven SARS-COVID-19 fourth Wave in Patients in a Private Health Care Setting in South Africa
Abstract : Introduction: The COVID-19 pandemic has had a global impact on travel, tourism, businesses, economies, and capital in general. In South Africa, COVID-19 continues to impact the economy, lives, and livelihood of its citizens. COVID-19 has also brought on some financial pressures on the health sector with poorly resource..
- Mallampati Score, ASA Physical Status Class, Medical Direction: Should We Overcome The Billable Mirage? Should We Discard The Mandated Redundancies?
My opinion: The question is whether American Society of Anesthesiologists (ASA) is a stakeholder who is consulted before the Centers for Medicare & Medicaid Services (CMS) finalizes and publishes its annual policy about Medicare payments for physician anesthesiologists and other anesthesia providers under the Physician Fee..
- Quantifying Limits Of Diversity In The Times Of Digital Singularity Becoming The Biggest Enslaver Ever Known In The History Of Global Humanity
My opinion: It is way too early to raise the question about the ceiling of diversity when even the floor of diversity has not been penetrated although we may never know when we have breached the lower limit of diversity until and unless we have quantified it [1]. In nature, selection pressures seem to automatically define and refi..
- Just Like HeLa Cells, Who Owns Banked Biomes?
My opinion: We grew up in developing countries and knew only about blood “component” banks. Then we moved to a developed country and were introduced to tissue “sperm” banks. Now we are expecting that the developed group of nations may be looking up to the developing group of nations for filling up poop “biome”..
- Does Growth Hormone Need the Growth? Maybe Not Anymore
My opinion: We have always tried to be the seekers of the facts. But as the facts keep evolving with our constantly evolving understandings, the facts seem to lose the battle to the truths. The truths seem to give an uncanny stability to the minds whose beliefs in their truths become the absolutes, immune to the wavered evolution ..
- Colon Reparation After Colonoscopy
My opinion: The science of biomes has continued to grow during the ongoing global pandemic. COVID-19 has affected our biomes. The use of protective gear limits the ability of biomes to replenish while the absence of social contact limits biomes’ diversity. Our eating habits (processed foods) have also changed as we have quaranti..
- Prism of evolution
My opinion: Humanity sees and reflects through the prism of innumerable -isms. The number of -isms keeps expanding as human language blooms and human interpretation glooms. As human language evolves with time, human interpretation devolves with time. Thereafter, humanity looks back into its past and interpret its past with the pri..
- Transverse Abdominis Plane Block And Rectus Sheath Block Medication Depots
My opinion: Uncertainty exists related to the appropriate perioperative period to perform a transverse abdominis plane (TAP) block [1]. This block could be performed preoperatively, after induction of anesthesia with or without tracheal intubation, before closure of the surgical incision, before emergence from anesthesia with o..
- Are De Novo Adverse Adulthood Experiences (AAEs) Extensions Of Adverse Childhood Experiences (ACEs) Figuratively Or Literally? Create Positive Adulthood Experiences (PAEs) Just Like Positive Childhood Experiences (PCEs) To Counter Adversities
My opinion: Over the last few decades, Adverse Childhood Experiences (ACEs) [1-3] have been documented to play a role in the evolving pathophysiology among modern humans. However, humanhood does not end once childhood evolves into adulthood. Moreover, chronological age may NOT always reflect mental age [4-5] of each and every mode..
- Nova Neoteny
My opinion: Although neoteny is persistence of pre-mature forms like childhood well into the periods of mature forms’ stages like adulthood, age and its corresponding maturity level is just a number doing a number on evolved humans whereby presumption of maturity per age is obviating the need to mature before age. Counterintuiti..
- Can Adverse Correctional Experiences Lead To Third Victim Syndrome?
My opinion: We talk about the first victim and the second victim syndrome [1-5]. However, we must also look into the third victim. The third victim may be fictional entities like corporations, towns, communities, societies and nations. However, much before the final step taken by these fictional entities to dissolve themselves und..
- Mirror O Mirror On The Floor, Come Closer To Look At My Face!
My opinion: Compared to prone patients in ProneView® Protective Helmet Systems [1] whose faces can be monitored via mirror bases built into them, the faces of patients whose heads are immobilized in prone position by pinning [2] can only be visualized in ergonomically challenging positions wherein anesthesia providers have to ..
- Double-Edged Pandemic, Just Like War, Shedding Off Population Over-A-Barrel At Both Ends
My opinion: By being not born [1-3] and by being dead, pandemic like war [4-8] is leading to so much human suffering individually even though evolutionarily humanity will futuristically term it as population stabilizing strategy (PSS) because humanity does not like to listen to or learn from the evolutionarily stable strategy of..
- Avoiding Work Authorization Status Related Conscious And Explicit Bias
My opinion: As elicited by Balhara et al [1], graduate medical education (GME) in the United States (US) is finally lapping up to objectively recognize and ostracize bias [2]. However, this pursuit of equitable recruitment freed of unconscious and implicit bias will be incomplete without addressing the conscious and explicit bia..
- ASK THE REASON FOR THE CHOICE: Who/What Chooses Anesthesia Type: Procedure, Patient, Provider, Proceduralist, Place, Phase, Payer, Player? It's Just Time
My opinion: There is always an ego which is the cooperative nuance evolving from the negotiation between the all-survivalist id and the all-altruist superego [1]. One of that ego is to choose the type of anesthesia. Now the question arises who chooses the type of anesthesia. Is it the patient? Is it the provider providing an..
- LOSING SLEEP OVER SLEEP: Is it auto-cannibalism when, while providing healthcare to sleepless society, healthcare of sleepless sweaters gets disrupted?
My opinion: After reading the article about our evolution into zombie nation [1-3], I was reflecting how humanity may have gotten to this stage. I may have some insight so I will start by pondering on my personal story. My day used to begin at 0900 hours. That lasted for three years. Then my day started to begin at 0830 hours. Tha..
- Antibiosis: "Dear Microbiome, Are You Dead Yet?" Probiosis: "Maybe Never, Must Be Never."
My opinion: Since watching movie "Kiss the Ground" [1], it has been fascinating personal enterprise to foresee personal "Poop in the Loop" [2]. However, neither the ground has been kissed nor the poop has been looped. Henceforth, the deeds which could not be completed are being documented as the deeds which should have been a..
- "Dear substance! please leave me alone," humane plea falling on deaf ears of substance
My opinion: Although we call it to be substance abuse when humans abuse substances, it may rather be the other way around where substances are abusing humans not unlike domestic abuse [1] whereby humans are victims and substances are perpetrators which human systems can only seize and burn while in the meantime human victims ..
- Tattoo Story Is Like Hair Story: Restoration Of Self-Identity In The Anonymizing World
My opinion: Just like the hair story [1], the tattoo story [2-3] may be about searching a safe place within to create an identity while opponents may be trying to obliterate the creation of that identity. It does not mean that opponents may not create any identity because even being hair-less or tattoo-less is an identity in its..
- Kissing HPV or Kissing It Goodbye: Time To Reinvent Mass Media Strategy To Increase Acceptance Of HPV Vaccination Among Parents And Their Young Wards
My opinion: As physicians, some of us first encountered the plight of human papillomavirus (HPV) among their patients once they moved across the continents. Surprisingly, those first observed episodes were among toddlers and even infants presenting for surgical management of recurrent respiratory/laryngeal papillomatosis under..
- Simplest definition of "CAGE" abuse: Whenever freedom to quit is absent, abuse is happening
My opinion: Perception of abuse in human terms happens when a human wants to quit and move away from a situation but cannot quit and move away [1]. Perpetuation of violence in human terms happens when a human must quit and move away from the abusive situation but does not quit and move away from that abusive situation. The co..
- Can induction of general anesthesia with propofol and/or delivery of baby with cesarean section convert maternal atrial fibrillation into maternal sinus rhythm?
Case Report: There have been some case reports about propofol being antiarrhythmic [1-2]. Herein, after obtaining patient's informed and written consent, we want to share a case history wherein when delivery of baby with cesarean section happened immediately (within four minutes) after induction of general anesthesia with pr..
- Effect of COVID-19 Misinformation Among Adults of the Southern U.S.
Abstract: The COVID-19 pandemic is the worst health crisis in the world in the last 100 years with devastating effects on human lives and with severe economic and social disruption. Unfortunately there is a lot of misinformation about COVID-19, which is disseminated widely in social media. Misinformation is highly prevalent glob..
- Will Medically Consulting Anesthesiologists Supersede Medically Supervising Anesthesiologists And Replace Medically Directing Anesthesiologists?
My opinion: I am deciding to not wait for my early/normal/late and forced/unforced retirement to ask the question [1] which may heal anesthesiology, the Fisher King. The healing question "Whom does the Grail serve?" [2] has been and will always be wide open to interpretations depending on who, why, when and where. For me as a ..
- Can Long Straw Sipper Bottle Keep Masked Flyers Calm During Long-Haul Flights? It Maybe Worth Investigating
My opinion: Incidents of bad behavior during flights are growing most likely due to the mandates to wear masks. These badly behaving flyers may blame it all on their intolerance to wearing masks especially during long-haul flights. The critics of these badly behaving flyers may blame it all on these flyers' belief systems p..
- Tele-Kin Against Addiction
My opinion: I had a dream. I thought that I will pursue addiction medicine. But, in the absence of pursuit and execution [1], this vision has turned into a hallucination. I had a dream. I thought that healthcare will evolve into telemedicine-only model [2]. But, to keep the dying status quo breathing [3], in-person healthcare mode..
- Are Fecal Capsules As Pro-Biotic Making The Case For Seminal Capsules As Anti-Eclamptic? Worth Exploring For The Future Of Safer Assisted Reproductive Technology
My opinion: The questions we must ask ourselves. Is human body composed of not only human cells but also non-human cells like microbes numbering in trillions [1]? Do these microbes turn human gastrointestinal tract into the biggest immune system that human body has [1-2]? Have modern human beings learnt to lose their microbiome b..
- Is It Apophenic Bet on Bats to Search for SARS-CoV-0 as Prequel and Prepare for SARS-CoV-X as Sequel to COVID-19 Pandemic?
My opinion: My imagination has always run wild but it is running amok since COVID-19 pandemic. Currently, the question bugging me is “if pandemic had started with bat-consumption [1-2], will pandemic end with bat-consumption too?” as if lyrics penned by Qateel Shifai and sung by Jagjit Singh that translate as “He/She/It who/..
- GO PRONE With Shithilaasana: Can Transcranial Doppler Ultrasound Confirm If Good Lobe/Segment Down Turns SARS-CoV-2 Inflamed Bad Lobe/Segment Into Zone-1 With Dead Space Ventilation Shutting Off Blood Flow Through Microemboli-Throwing Pulmonary Arteriovenous Channels Functionally Opened By SARS-CoV-2 In Bad Lobe/Segment?
My opinion: Physiologically, humans just like animals involuntary adjust their postures and positions so that they can easily breathe without giving much thought as to how they are adjusting and adapting their postures and positions to keep that ease in their breathing. Although respiratory physiology may seem too complex even to ..
- A cross-sectional analysis of the motivational factors that influence students of diverse backgrounds to study medicine-exploratory study
Abstract : Background Students apply to study medicine with intrinsic motives of genuine interest and sheer passion about the subject (intrinsic motivation) or external motives such as status, or family endorsement (controlled motivation). Pertinent to the motivation; intrinsic versus controlled motivation, students’ adaptation..
- EGFR TKIs IN NON-SMALL CELL LUNG CANCER: HEAD AND TAIL OF THE COIN
Abstract : TKIs against the human EGFR have become standard of care for patients with advanced EGFR mutant NSCLC. But despite the initial good results with first generation EGFR TKIs, patients’ cancers will progress after a median duration of response of around 12 months. And some patient will not even show response or only for..
- Health Care Infinity: Prohibit Regulate Normalize
My opinion: Humanity should look much further beyond short-term vision for Health Care 2030 [1] because existential questions are so many and answers to them are so few, if any, when some do everything and some do nothing while few, if any, relish the endgame to exist in matrix. What have been the primary gains to the humanity du..
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