Neuroinflammation, diabetes, and COVID-19: Perspectives coming from Ca2+/cAMP signalling

Background: A link between inflammatory diseases, e.g., epilepsy, dementia, diabetes, and COVID-19, has been established. For instance, observational studies with several individuals established that people with epilepsy have shown an enhanced incidence of manifesting dysfunctions related to cognition, e.g., dementia, while people with dementia have a higher incidence of manifesting epilepsy, thus an evident bidirectional relationship between epilepsy and dementia might occur. In addition, epilepsy commonly cooccurs in patients with diabetes, so an association between these two disorders is also discussed. Intriguingly, some reports have also observed a poor prognosis for people with both diabetes and COVID-19. It is recognized that a dyshomeostasis of both Ca2+ and cAMP signalling pathways could be a molecular connection for these disorders. Objectives: Therefore, clarifying this clinical relationship among epilepsy, dementia, diabetes, and COVID-19 may outcome in novel hypotheses for identifying the etiology of these disorders.

Comprehensive Analysis of REST/NRSF Gene in Glioma and Its ceRNA Network Identification

We sought to clarify the clinical relationship between REST/NRSF expression and the prognosis of glioma and explore the REST-associated competitive endogenous RNA (ceRNA) network in glioma. We downloaded RNA-seq, miRNA-seq and correlated clinical data of 670 glioma patients from The Cancer Genome Atlas and analyzed the correlation between REST expression, clinical characteristics and prognosis. Differentially expressed genes (DEGs) were identified with DESeq2 and analyzed with Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) using the Profiler package. Starbase was used to explore the regulatory interaction between REST and miRNAs or LncRNAs. The lncRNA-miRNA-REST ceRNA network was constructed with Cytoscape. RT-qPCR, WB, CCK8, wound-healing, and luciferase assays were performed to validate the ceRNA network. Results showed that REST expression was significantly higher in glioma patients than normal samples. Higher REST expression was significantly associated with worse overall survival, progression-free interval, and worse disease-specific survival in glioma patients. The DEGs of mRNA, miRNA, and lncRNA were identified, and GO and KEGG enrichment analyses were performed. Finally, REST-associated ceRNA networks, including NR2F2-AS1-miR129-REST and HOTAIRM1-miR137-REST, were experimentally validated. Thus, REST may be a prognostic biomarker and therapeutic target in glioma, and its regulatory network validated in this study may provide insights into glioma's molecular regulatory mechanisms.

Prophylaxis and treatment of pulmonary thromboembolism in COVID-19 patients

In 2019, a completely unique pneumonia, called coronavirus disease 2019 (COVID-19), spread rapidly throughout the planet. This novel global pandemic severely threatened public respiratory health and medical services. To date, apart from the common respiratory symptoms, coagulation disorders, especially Pulmonary Thromboembolism (PTE), has been proven as a crucial complication in severe COVID-19 patients, and therefore the incidence of PTE causes poor clinical outcome and increased fatality. Therefore, it’s important that healthcare providers, including respiratory physicians, medicine specialists, hematologists, cardiologists, communicable disease specialists, and other specialists, recognize that patients with COVID-19 are at increased risk of PTE, and make sure that appropriate prophylaxis is run to the acceptable patients, which they effectively manage PTE when it does occur. The mechanism of PTE in patients with coronavirus pneumonia consists of endothelial injury, activated platelet, cytokine storm, and a suppressed fibrinolytic system. Early prophylaxis, antiviral therapy, anticoagulation, and supportive treatment are beneficial to COVID-19 patients. In this review, we summarize the harm that coronavirus pneumonia wreaks and highlight the clinical relationship between PTE and coronavirus infection. The potential mechanism and therefore the prophylaxis and therapeutic measures also are discussed to involve more effort and research to research the strategies for PTE in COVID-19.

What are the ethical conflicts faced by Mexican internists?

Background No studies have been conducted in Mexico to ascertain what ethical problems doctors working at hospitals deal with. This article aims to describe the ethical conflicts most commonly identified by Mexican internists and the importance they attribute to each of these conflicts. Methods Voluntary survey to the members of the Internal Medicine Association of Mexico. Results Responses were submitted by 347 internists. Half of those face ethical conflicts almost always or frequently. The most commonplace and relevant conflicts are those resulting from the clinical relationship (communication, confidentiality, informed consent, assessment of mental capacity, decisions involving incapacitated patients, and conflicts with family members), and secondly those problems related with the end of life (palliative care, withholding or withdrawing treatment, and “No CPR orders”). To resolve conflicts they seek support through protocols, Institutional Ethics Committees (IECs), and consultations with colleagues and, occasionally, with bioethics experts. Protocols and IECs are the tools most in demand among them. Conclusions 1) the most frequent and relevant conflicts are those caused by the clinical relationship, above all those due to doctor–patient communication, and secondly those due to problems which arise at the end of life; 2) though nearly all of them have doubts about how to resolve conflicts, the vast majority are satisfied with the way in which they do so; 3) to deal with conflicts, they seek support mainly in protocols, IECs, and consultation with colleagues; and 4) in order to resolve them better, what they most demand are protocols and IECs, but also bioethics consultants.

Aortic stiffness in degenerative aortic stenosis

Aortic stenosis (AS) is one of the most common cardiovascular diseases. The prevalence of AS and vascular stiffness are significantly associated with age. Elevated arterial stiffness is an independent risk factor for cardiovascular events. The pathogenetic and clinical relationship of degenerative AS and aortic stiffness is poorly known. This review reflects the current understanding of the relationship between degenerative AS and aortic stiffness. The existing evidence on the effects of surgical and endovascular correction of the defect on aortic stiffness is described. The potential predictors of AS prognosis and outcomes of valve replacement are discussed. Unresolved issues and directions for further research are clarified.

Healing Metaphors

Patients and physicians come together in the clinical relationship as individuals, not as representatives of a set. The patient seeks to understand the meaning and import of illness and benefits from the comfort and reassurance offered by a trusted physician. The physician fulfills these obligations by providing the requisite expertise, calm demeanor, and modesty of listening to understand the patient’s specific needs. Clinical care is a customized craft, and words are actions that must be suited to the details of the illness and the nature of the ailing person. It demands a physician with a flexible mind and a tolerant attitude who also appreciates the joys of human interactions. Words must be thoughtfully selected in measured doses in order to provide healing and minimize toxicity. This chapter examines the importance of alterity, the trait of humility, and the nature of metaphors that heal. It concludes with the duties of physicianship, the character of the physician, and language as the medium that makes healing possible.

A Pharmacology of Words

This chapter proposes that placebos are best understood as a metaphor in which words (and doctors) are drugs and can thereby alleviate symptoms and promote healing. Placebos may be chemically inert, yet they possess clinical potency. Various explanations for the placebo effect have been proposed, including conditioning, expectancy, meaning response, and ritual, and the relevant causal neural mechanisms are reviewed. The chapter examines the paradox of the widespread use of placebos and the mistrust they often elicit, while reviewing the importance of the patient’s and physician’s belief in the impact of words and ritual. The various types are noted, including hidden or covert placebos, open-label placebos, and socially transmitted placebos. The chapter emphasizes the importance of context and the clinical relationship in the benefits provided by this long-underappreciated clinical phenomenon.

The Physician–Patient Relationship

Health care takes place in the relationship between patient and physician that is crafted mutually and relies crucially on the words and behaviors of the participants. The physician has a duty of care to the person who is ill and must therefore engage fully to respond to the needs of the patient. A language of alliance and shared goals that are clearly communicated shifts the doctor’s attention from the disease to the patient. This chapter examines schemas that have been put forward to characterize the clinical relationship and critiques the dual discourses that separate science and art, and posit technical skills and humane attentiveness as competing frames. It reviews phenomenological analyses of the clinical interaction and cautions against a form of autonomy and empowerment that permits clinicians to shed their responsibilities. The chapter explores clinical presence and relational understanding as necessary features of responsive and responsible clinical care.