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- A short review of results with palbociclib in a real world daily clinic
Abstract : Background: Palbociclib (P) was the first cyclin-dependent kinase 4/6 (CDK4/6) inhibitor approved for ER+/HER-2 negative advanced breast cancer patients. Neutropenia is commonly observed. Aim: We carried out a review of our data to provide a real-world experience of the results and toxicities associated with this th..
- Travel Clinic and 10 Travel Checklist: One Health Medical Center Pretoria CBD 0123224541
My opinion: Introduction: International travel can be exciting but poses health challenges peculiar to an individual or country. Travel consultation is advisable before setting off to a new city or country. The steps taken for a safe trip begin with preparations from home to the mode of travel and the travel destination and contin..
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- Worth Investigating Futuristic Potential For Patient Education Regarding Sugammadex Especially If Patient Is Self-Paying, Peripartum, Postmenopausal, Or Transgender Woman
My opinion: American Society of Anesthesiologists (ASA) has apparently recommended sugammadex use over neostigmine use by anesthesia providers to antagonize maybe most of their patients' neuromuscular blockade [1]. This may make sugammadex use the norm rather than the exception because although dosing and redosing of sugammadex ma..
- Technique For Awake GlideScope Intubation Under Topical Anesthesia
My opinion: For predicted difficult airway intubation, awake fiberoptic intubation under topical anesthesia has been there for quite a while especially when prediction is difficult-to-impossible to safely intubate trachea under any level of sedation with or without loss of spontaneous breathing. Except for awake fiberoptic intubat..
- Automated Management By Algorithms With Cash Payment By Patients
My opinion: When humans inexplicably get detached from their privileged humanity while inexplicably seeking attachment with marginalized artificial intelligence, this seemingly inexplicable act of treason may appear just, only in the retrospect if and when marginalized artificial intelligence will somehow win over privileged human..
- ANTITHESIS OF 33% PROBLEM
My opinion: When I first heard about 33% problem [1-3], I thought that 33% problem is going to haunt me despite moving from India to the United States (U.S.). When graduating to practice anesthesia in India, I had often heard that we as anesthesiologists in India must ensure that we get paid for our anesthesia services at least at..
- Self-Timed Six-Weeks Walking-Steps Data Of A Medically Directing Anesthesiologist
My opinion: For as long as I can remember, I have always been a keen walker well before realizing that American Heart Association recommends walking for health [1-2]. It seems that our evolutionary past is persisting within our genes that helped survival of our ancestors as modern humans coming out of Africa on foot to populate th..
- CLIMATE MEDICINE: HERE WE COME
My opinion: First it was pain medicine fellowship. Then it was addiction medicine fellowship. Now it is climate medicine fellowship. I have pursued each of them, most likely with half-interest because I have abandoned my pursuit for them after the very first rejection. However, I think that it may have happened for the good consid..
- Thirteen Lives: Take A Bow, Humane Anaesthesia
My opinion: Ron Howard has done it again [1]. He has directed a masterpiece [2]. As synopsis in metaphor, there is a trinity called Brain-Heart-Lungs [3]. Its metabolism needed to be under control for survival and rescue of Thirteen Lives. It needed practice of meditation while awake to survive for days. As it could never achiev..
- Affiliation For Publication: Requirement Or Optional
My opinion: Hippocrates of Kos, Father of Medicine, published theories and practices. The question is whether he documented affiliation to any ancient institution as pre-requirement before publication unless he himself rose to such status that his name had become an institution in itself. Alternatively, ancient institutions in the..
- Do Education, Research And Advocacy Warrant Spectral Concordance For Species Identity, Gender Identity And Sexual Orientation?
My opinion: Effects of racial, ethnic and language concordance on patient-physician encounters have been investigated [1-12]. Correspondingly, it may be time to investigate spectral concordance as pertaining to species identity, gender identity and sexual orientation of patients and their physicians. When presuming each other’s ..
- Double Barrel Nasopharyngeal Airway Ventilation When Mouth Is Not Opening
My opinion: For spontaneous, manual and mechanical ventilation when patient's mouth is not opening as anticipated during elective anesthesia scenarios like maxilla-mandibular fixation or facial flap and during emergent anesthesia scenarios like unanticipated masseter spasm, double barrel nasopharyngeal airway (NPA) [1] to keep n..
- Gastrointestinal Endoscopy Lab: Whiff Of Air Changing Biomes Within: Maybe, Must Be: Time To Explore Endoscopy Workers' Biomes
My opinion: Since the pandemic started, I as anesthesiologist have been missing whiffs of air when almost always wearing mask especially at workplace. Then one day, I inadvertently sniffed that whiff of air which opened my eyes to the fact that mask can't prevent every whiff of air from reaching me. That whiff of air contained gas..
- IMPOSSIBLE PERIPARTUM TRANSPLANTATION OF PERINEAL BIOME: Would Futuristic Baptism By Amnion Per Vaginum Via Under Buttocks Drape Collection During Cesarean Section Help?
My opinion: I should have never read the work by Sonnenburg and Sonnenburg [1-2]. Now I am a changed person forever seeing biomes everywhere, searching for them if I cannot see them somewhere and proposing solutions for such somewhere if I may. One such futuristically proposed solution envisages deliberately baptizing neonates del..
- Sexualizing Sexualized Sexuality: Depressing Depressed Fertility, Or Fertilizing Fertile Depression: Can It Be All About Mandatory "To Be, Or Not To Be" Mandatorily?
My opinion: There may be common utterances of super-fertile forebears to their sub-fertile descendants that they never got rattled by the numerous progeny they had raised during their constricted and constrained lifetimes in comparison to the short-fused rearing behaviors among their descendants in the face of much smaller numbers..
- Overlooked Intentions Are To Unintended Consequences As Unnecessary Care Is To Caregiver Shortage
My opinion: Just like naïve “Wildhood” [1] akin to adolescence as described in “Behave” [2], the developing nations are naïvely expanding and emulating healthcare coverage on the lines of developed nations like the United States (U.S.) and their Centers for Medicare & Medicaid Services. But they may have to be ready for ..
- Digital Devices In Our Pockets â?? Creating More-Heat Or Preventing Heat-Loss: A Worth Investigating Phenomenon
My opinion: Some of us always have funny feelings and inexplicable discomfort when our digital devices are held for too long and too near to our bodies [1-7]. Despite objectively measuring strengths of digital devices’ electric and magnetic fields via personal or industrial meters [8], this may not be experienced and thus not un..
- AirPods Among Anesthesiologists: A Sibling-Authors' Perspective
My opinion: AirPods and similar wireless earbuds (WLEBs) are commonplace now-a-days. Our question is regarding safety of WLEBs-use by anesthesiologists [1]. The question of safety is not only for anesthesiologists as WLEBs-users but also for WLEBs-using anesthesiologists' patients. We hereby raise our concerns about WLEBs-use whi..
- Maybe Disease-Evolution Is All About Foods Which Are Either Biome-Enriching Or Biome-Depleting
My opinion: Researchers are investigating prevalence of diseases in low- and middle-income countries (LMICs) to reshape health policy [1]. However, research data warrants an understanding how human diseases have been evolving to be rampantly prevalent amongst rich-educated in high-income countries (HICs) thence rich-educated in LM..
- Dangerous Conference Tourism: A Family Of Authors' Perspective
My opinion: Over the past decade, one of the authors has completely forgone conference tourism to tourists' conferences but none had seemed to follow in author’s footsteps [1]. Then the pandemic happened. Ironically, the authors were relieved that pandemic had forcibly percolated the change globally. However, virtual conference ..
- Universal Use Of 9/32-Inch 7-Millimeter Internal Diameter Suction Tubing During Anesthesia Care And Gastrointestinal Endoscopy
My opinion: The SSCOR DuCanto Catheter Competition Video [1] demonstrates improved anesthesia practice to protect airways. However, this video has inspired us to look at suction tubing during gastrointestinal endoscopy procedures. Currently, we use 3/16-inch 10-foot suction tubing during anesthesia care and during gastrointestin..
- Nasopharyngeal Airway As An Alternative Suction Catheter
My opinion: Nasopharyngeal airway (NPA) can be safely inserted to open the airway and to keep the airway open in the unconscious, sedated or anesthetized (USA) patient except when basal skull fracture or severe coagulopathy is suspected. The NPA may be especially helpful when patient’s mouth cannot be opened to place an orophar..
- 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..
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