Enhanced recovery after surgery in liver transplantation: Challenges and feasibility.

BACKGROUND: Enhanced recovery after surgery (ERAS) started a revolution that changed age-old surgical stereotypical practices regarding the overall management of the surgical patient. In the last decade, ERAS has gained significant acceptance in the community of general surgery, in addition to several other surgical specialties, as the evidence of its advantages continues to grow. One of the last remaining fields, given its significant complexity and intricate nature, is liver transplantation (LT). AIM: To investigate the existing efforts at implementing ERAS in LT. METHODS: We conducted a systematic review of the existing studies that evaluate ERAS in orthotopic LT, with a multimodal approach and focusing on measurable clinical primary endpoints, namely length of hospital stay. RESULTS: All studies demonstrated a considerable decrease in length of hospital stay, with no readmission or negative impact of the ERAS protocol applied to the postoperative course. CONCLUSIONS: ERAS is a well-validated multimodal approach for almost all types of surgical procedures, and its future in selected LT patients seems promising, as the preliminary results advocate for the safety and efficacy of ERAS in the field of LT.

Salivary diagnostics of the novel coronavirus SARS-CoV-2 (COVID-19).

INTRODUCTION: Laboratory testing for the SARS-CoV-2 virus and the consequent respiratory coronavirus disease 2019 (COVID-19) is categorized into methods that detect the viral presence and methods that detect antibodies produced in the host as a response to infection. Methods that detect viral presence into the host excretions measure current infection by SARS-CoV-2, whereas the detection of human antibodies exploited against SARS-CoV-2 evaluates the past exposure to the virus. OBJECTIVE: This review provides a comprehensive overview for the use of saliva as a specimen for the detection of SARS-CoV-2, the methods for the salivary diagnostics utilized till very recently, and the arisen considerations for the diagnosis of COVID-19 disease. CONCLUSION: The major advantage of using saliva as a specimen for the detection of SARS-CoV-2 is that saliva collection is a non-invasive method which produces no discomfort to the patient and permits the patients to utilize home self-sampling techniques in order to protect health providers from the exposure to the pathogen. There is an urgent need to increase the active research for the detection of SARS-CoV-2 in the saliva because the non-invasive salivary diagnostics may provide a reliable and cost-effective method suitable for the fast and early detection of COVID-19 infection.

Fitness Characteristics of Jordanian Emergency Medical Technicians.

INTRODUCTION: Emergency medical technicians (EMTs) should be always prepared to deal with the stressful condition of treating patients with serious physical and emotional injuries. Given that EMTs consider safety the first priority, they must pay adequate attention to their own physical well-being and fitness to practice. OBJECTIVE: The present study was conducted to analyze the fitness of Jordanian EMTs. METHOD: The present prospective study was conducted to evaluate the well-being of Jordanian paramedics. The survey was designed using Google forms, which were completed by the participants. The data collection tools comprised an already-designed checklist, including items such as age, gender as well as height and weight, which are used for calculating body mass index (BMI). In addition, the presence of chronic diseases such as hypertension, diabetes mellitus, renal failure and cardiorespiratory diseases as well as the history of surgeries and disabilities were investigated. The participants were also asked about their smoking status and other health-related habits. RESULTS: Out of 115 surveys conducted, 7 were discarded owing to loss of information or making completion mistakes. Out of the remaining 108 respondents, 82 (75.9%) were male and below 10% were over the age of 30 years. BMI was over 25 in 40.7% of the respondents, and only 4 (3.7%) had chronic diseases. Moreover, 46 (42.6%) respondents were smokers, and only 30 (27.8%) performed regular exercise. CONCLUSION: The present findings suggest health problems in a small percentage of the EMTs, potentially due to the appropriate support provided by the employers or university authorities in this regard. The major health problem was overweight and unhealthy lifestyle, including smoking and not doing regular exercise.

Salivary mRNA markers having the potential to detect oral squamous cell carcinoma segregated from oral leukoplakia with dysplasia.

BACKGROUND: In the current study the presence of extracellular IL-1B, IL-8, OAZ and SAT mRNAs in the saliva was evaluated as a tool in the early detection of oral squamous cell carcinoma. METHODS: 34 patients with primary oral squamous cell carcinoma stage T1N0M0/T2N0M0, 20 patients with oral leukoplakia and dysplasia (15 patients with mild dysplasia and 5 with severe dysplasia/in situ carcinoma) and 31 matched healthy-control subjects were included in the study. The presence of IL-1B, IL-8, OAZ and SAT mRNA was evaluated in extracellular RNA isolated from saliva samples using sequence-specific primers and real-time RT-PCR. ROC curve analysis was used to estimate the ability of the biomarkers to detect oral squamous cell carcinoma patients. RESULTS: The data reveal that the combination of these four biomarkers provides a good predictive probability of up to 80% (AUC=0.799, p=0.002) for patients with oral squamous cell carcinoma but not patients suffering from oral leukoplakia with dysplasia. Moreover, the combination of only the two biomarkers (SAT and IL-8) also raises a high predictive ability of 75.5% (AUC=0.755, p=0.007) approximately equal to the four biomarkers suggesting the use of the two biomarkers only in the prediction model for oral squamous cell carcinoma patients limiting the economic and health cost in half. CONCLUSION: SAT and IL-8 mRNAs are present in the saliva in high quality and quantity, with a good discriminatory ability for oral squamous cell carcinoma patients only but not for patients with oral leukoplakia and dysplasia an oral potentially malignant disorder.

Recovering circulating extracellular or cell-free RNA from bodily fluids.

The presence of extracellular circulating or cell-free RNA in biological fluids is becoming a promising diagnostic tool for non invasive and cost effective cancer detection. Extracellular RNA or miRNA as biological marker could be used either for the early detection and diagnosis of the disease or as a marker of recurrence patterns and surveillance. In this review article, we refer to the origin of the circulating extracellular RNA, we summarise the data on the biological fluids (serum/plasma, saliva, urine, cerebrospinal fluid and bronchial lavage fluid) of patients suffering from various types of malignancies reported to contain a substantial amount of circulating extracellular (or cell-free) RNAs and we discuss the appropriate reagents and methodologies needed to be employed in order to obtain RNA material of high quality and integrity for the majority of the experimental methods used in RNA expression analysis. Furthermore, we discuss the advantages and disadvantages of the RT-PCR or microarray methodology which are the methods more often employed in procedures of extracellular RNA analysis.

Salivary markers for oral cancer detection.

Oral cancer refers to all malignancies that arise in the oral cavity, lips and pharynx, with 90% of all oral cancers being oral squamous cell carcinoma. Despite the recent treatment advances, oral cancer is reported as having one of the highest mortality ratios amongst other malignancies and this can much be attributed to the late diagnosis of the disease. Saliva has long been tested as a valuable tool for drug monitoring and the diagnosis systemic diseases among which oral cancer. The new emerging technologies in molecular biology have enabled the discovery of new molecular markers (DNA, RNA and protein markers) for oral cancer diagnosis and surveillance which are discussed in the current review.

Oral lesions leading to the diagnosis of Crohn disease: report on 5 patients.

Crohn disease is a chronic granulomatous inflammatory disease of the gastrointestinal tract of unknown etiology. Oral lesions are significant, as they may occasionally precede intestinal and systemic manifestations. In this retrospective study, clinical and histopathologic data were reviewed from the files of 5 patients with Crohn disease diagnosed at the Department of Oral Medicine and Maxillofacial Pathology School of Dentistry, Aristotle University, Thessaloniki, Greece, and Division of Stomatology and Oral Surgery, Faculty of Medicine, University of Geneva, Switzerland. In the 5 patients, clinical signs included erosions, deep ulcers, cobblestoning of the buccal mucosa, mucosal tags, and lip swelling. Histopathologic examination revealed a granulomatous inflammation with noncaseating granulomas and deep fissuring of the oral mucosa. In all 5 patients, oral lesions were the early signs of the disease. The diagnosis of Crohn disease was confirmed by a colonoscopy and a biopsy of colonic lesions. Oral lesions may be significant and/or initial signs of Crohn disease. Recognition of the lesions may provide an early diagnosis.

Epidemiologic survey of pemphigus vulgaris with oral manifestations in northern Greece: retrospective study of 129 patients.

OBJECTIVE: To evaluate the epidemiology of pemphigus vulgaris (PV) in a Greek population and to compare it with other countries. MATERIALS AND METHODS: A retrospective study was conducted based on the records of 129 patients (41 males and 88 females) with PV who visited the Department of the Oral Medicine and Maxillofacial Pathology, Aristotle University of Thessaloniki, Greece and the State Hospital for Skin and Venereal Diseases of Thessaloniki, Greece, between 1985 and 2004. A group of 73 individuals was used as controls. RESULTS: The average annual incidence was found to be eight patients per year. The male to female ratio was 1 : 2.25. The difference in the age of onset between the two genders was statistically significant in marginal levels (P = 0.05). In addition, 86.1% of the patients showed oral lesions only, 13.3% oral and skin lesions and 1.3% manifested oral, skin, and ocular lesions. Twenty-eight of the 88 females were in the premenopausal period-of-life. Additionally, 19 males were farmers who had daily contact with organophosphoric pesticides. Co-existing pathologic conditions were present in 75 of the 129 patients, and of these 75 patients six (8%) were diabetics, 15 (20%) presented with hypertension, two (2.6%) faced problems from their thyroid gland, and 10 (13.3%) of the patients complained of allergic reactions. CONCLUSIONS: The results of this study demonstrated a relatively high incidence of PV in northern Greece compared with that in other countries. The disease most frequently occurred in the sixth decade-of-life and the majority of the patients manifested oral lesions. Further epidemiological studies are needed to elucidate whether this region is constituted from population groups with high susceptibility to PV.