A Review of the Biosynthesis and Structural Implications of Insulin Gene Mutations Linked to Human Disease.

The discovery of the insulin hormone over 100 years ago, and its subsequent therapeutic application, marked a key landmark in the history of medicine and medical research. The many roles insulin plays in cell metabolism and growth have been revealed by extensive investigations into the structure and function of insulin, the insulin tyrosine kinase receptor (IR), as well as the signalling cascades, which occur upon insulin binding to the IR. In this review, the insulin gene mutations identified as causing disease and the structural implications of these mutations will be discussed. Over 100 studies were evaluated by one reviewing author, and over 70 insulin gene mutations were identified. Mutations may impair insulin gene transcription and translation, preproinsulin trafficking and proinsulin sorting, or insulin-IR interactions. A better understanding of insulin gene mutations and the resultant pathophysiology can give essential insight into the molecular mechanisms underlying impaired insulin biosynthesis and insulin-IR interaction.

Postoperative nosocomial COVID-19 infection in surgical patients during pandemic: A prospective observational cohort study.

Background: increased pressure on healthcare systems and possible risk of nosocomial COVID-19 infection during pandemic urged many guidelines to severely restrict the number of operations. The aim of this study was to investigate the risk of COVID-19 infection and its complications in patients undergoing urgent or elective operations.Methods: a prospective observational cohort study was conducted in a tertiary surgical center and all patients with no preoperative history of COVID-19 undergoing elective or emergent surgeries were included in this investigation. chest computed tomography (CT) scan or polymerase chain reaction (PCR) test were performed on patients before and after surgery. Results: 183 patients who underwent an operation were enrolled in this study. In postoperative follow-up, 12 patients were positive for COVID-19 infection as identified by RT-PCR and non-contrasted chest CT scans. Regrettably, 2 individuals passed with one of these individuals dying as a direct result of COVID-19 infection. All the 12 cases of post-operative COVID-19 patients underwent elective surgeries. Conclusion: the gathered results indicate a need for the re-evaluation of the risks of operation during the COVID-19 pandemic. If operations are performed while observing protective and preventative protocols, the risk of post-operative nosocomial COVID-19 is significantly reduced. Hence, the consequences imposed on patients by the delay or cancellation of operations (most notably in cancer cases) may outweigh the risk of post-operative COVID-19 infections.

A novel surgical solution to impossible fascial closure due to contaminated abdominal cavities: A case report.

INTRODUCTION: Chronic, large, and old incisional hernias often lead to surgical complications and major hindrances during emergent laparotomies. The most challenging stages of the laparotomy in such cases occur during opening and fascial closure. CASE PRESENTATION: This article explains the novel surgical technique employed for the complex abdominal closure upon concluding an emergent laparotomy on a 68-year-old female patient. This innovative technique is appropriate for patients with contaminated abdominal cavities and scant fascia who require abdominal operations in cases where biological mesh is not available or is not a viable option. CONCLUSION: This surgical technique can help surgeons restrict abdominal contents and organs (particularly the bowel loops) and prevent migration out of the abdominal cavity during the early post-operative stages, hence, reducing post-surgical complications. The discussed surgical technique ensures that the abdominal fascia defect is limited using skin flaps. This defect later develops into a small hernia sac within a few weeks. Patients then need to have a secondary delayed elective operation on this significantly smaller sized hernia for repair using synthetic mesh.