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Cusick AS, Patel A, Fabbro SK. Ethics surrounding animal products in dermatology. J Am Acad Dermatol 2024:S0190-9622(24)00821-1. [PMID: 38823683 DOI: 10.1016/j.jaad.2024.05.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 06/03/2024]
Affiliation(s)
| | - Aneesha Patel
- Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio
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2
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de Melo LF, Almeida GHDR, Azarias FR, Carreira ACO, Astolfi-Ferreira C, Ferreira AJP, Pereira EDSBM, Pomini KT, Marques de Castro MV, Silva LMD, Maria DA, Rici REG. Decellularized Bovine Skeletal Muscle Scaffolds: Structural Characterization and Preliminary Cytocompatibility Evaluation. Cells 2024; 13:688. [PMID: 38667303 PMCID: PMC11048772 DOI: 10.3390/cells13080688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Skeletal muscle degeneration is responsible for major mobility complications, and this muscle type has little regenerative capacity. Several biomaterials have been proposed to induce muscle regeneration and function restoration. Decellularized scaffolds present biological properties that allow efficient cell culture, providing a suitable microenvironment for artificial construct development and being an alternative for in vitro muscle culture. For translational purposes, biomaterials derived from large animals are an interesting and unexplored source for muscle scaffold production. Therefore, this study aimed to produce and characterize bovine muscle scaffolds to be applied to muscle cell 3D cultures. Bovine muscle fragments were immersed in decellularizing solutions for 7 days. Decellularization efficiency, structure, composition, and three-dimensionality were evaluated. Bovine fetal myoblasts were cultured on the scaffolds for 10 days to attest cytocompatibility. Decellularization was confirmed by DAPI staining and DNA quantification. Histological and immunohistochemical analysis attested to the preservation of main ECM components. SEM analysis demonstrated that the 3D structure was maintained. In addition, after 10 days, fetal myoblasts were able to adhere and proliferate on the scaffolds, attesting to their cytocompatibility. These data, even preliminary, infer that generated bovine muscular scaffolds were well structured, with preserved composition and allowed cell culture. This study demonstrated that biomaterials derived from bovine muscle could be used in tissue engineering.
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Affiliation(s)
- Luana Félix de Melo
- Graduate Program in Anatomy of Domestic and Wild Animals, University of São Paulo, São Paulo 03828-000, Brazil; (L.F.d.M.); (A.C.O.C.); (R.E.G.R.)
| | | | - Felipe Rici Azarias
- Graduate Program of Medical Sciences, College of Medicine, University of São Paulo, São Paulo 03828-000, Brazil;
| | - Ana Claudia Oliveira Carreira
- Graduate Program in Anatomy of Domestic and Wild Animals, University of São Paulo, São Paulo 03828-000, Brazil; (L.F.d.M.); (A.C.O.C.); (R.E.G.R.)
- Center of Human and Natural Sciences, Federal University of ABC, Santo André 09210-170, Brazil
| | - Claudete Astolfi-Ferreira
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo 03828-000, Brazil; (C.A.-F.); (A.J.P.F.)
| | - Antônio José Piantino Ferreira
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo 03828-000, Brazil; (C.A.-F.); (A.J.P.F.)
| | - Eliana de Souza Bastos Mazuqueli Pereira
- Graduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marília (UNIMAR), Marília 17525-902, Brazil; (E.d.S.B.M.P.); (K.T.P.); (M.V.M.d.C.); (L.M.D.S.)
| | - Karina Torres Pomini
- Graduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marília (UNIMAR), Marília 17525-902, Brazil; (E.d.S.B.M.P.); (K.T.P.); (M.V.M.d.C.); (L.M.D.S.)
| | - Marcela Vialogo Marques de Castro
- Graduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marília (UNIMAR), Marília 17525-902, Brazil; (E.d.S.B.M.P.); (K.T.P.); (M.V.M.d.C.); (L.M.D.S.)
| | - Laira Mireli Dias Silva
- Graduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marília (UNIMAR), Marília 17525-902, Brazil; (E.d.S.B.M.P.); (K.T.P.); (M.V.M.d.C.); (L.M.D.S.)
| | | | - Rose Eli Grassi Rici
- Graduate Program in Anatomy of Domestic and Wild Animals, University of São Paulo, São Paulo 03828-000, Brazil; (L.F.d.M.); (A.C.O.C.); (R.E.G.R.)
- Graduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marília (UNIMAR), Marília 17525-902, Brazil; (E.d.S.B.M.P.); (K.T.P.); (M.V.M.d.C.); (L.M.D.S.)
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Aili R, Nakata H, Miyasaka M, Kuroda S, Tamura Y, Yokoi T, Kawashita M, Shimada Y, Kasugai S, Marukawa E. Evaluation of a hydroxyapatite-crosslinked fish gelatin membranes. J Dent Sci 2024; 19:900-908. [PMID: 38618111 PMCID: PMC11010609 DOI: 10.1016/j.jds.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/11/2023] [Indexed: 04/16/2024] Open
Abstract
Background/purpose Porcine collagen is widely used in regenerative therapies to generate membranes for bone augmentation. However, porcine or bovine gelatin or collagen is often not appropriate for patients with creed and religious beliefs or for allergic reasons. In this study, we evaluated the potential of fish gelatin to generate membranes. Materials and methods Fish gelatin and hydroxyapatite (HAp) were used at three different ratios (2:0, 2:1, 2:1.5, and 2:2) to prepare gelatin-hydroxyapatite (G-HAp) membranes via freeze-drying and heat-crosslinking. The surface morphology and cell attachment of G-HAp membranes were observed using scanning electron microscopy and confocal laser microscopy. G-HAp membrane was placed at the bottom of a well plate, and MC3T3-E1 cells were seeded on it. Cell viability and cytotoxicity were tested after 1 and 3 days of culture. Alkaline phosphatase (ALP) and alizarin red staining was performed at 10 and 21 days, respectively. Results Viability of cells on G-HAp membrane with the gelatin:HAp ratio of 2:1.5 was significantly higher than that on membranes with other gelatin:HAp ratios. ALP and alizarin red staining showed that ALP-positive areas and calcium deposition were the highest on G-HAp membrane with the gelatin:HAp ratio of 2:1. These membranes showed negligible cytotoxicity. Conclusion Fish-derived G-HAp membranes have the potential to promote osteogenic differentiation of MC3T3-E1 cells with negligible cytotoxicity.
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Affiliation(s)
- Reziwanguli Aili
- Department of Oral Implantology and Regenerative Dental Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Regenerative and Reconstructive Dental Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hidemi Nakata
- Department of Oral Implantology and Regenerative Dental Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Regenerative and Reconstructive Dental Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Munemitsu Miyasaka
- Department of Oral Implantology and Regenerative Dental Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Regenerative and Reconstructive Dental Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinji Kuroda
- Department of Oral Implantology and Regenerative Dental Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Regenerative and Reconstructive Dental Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Improvement of Gnatho-oral Function, Department of Stomatognathic, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Yukihiko Tamura
- Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taishi Yokoi
- Institute of Biomaterials and Bioengineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masakazu Kawashita
- Institute of Biomaterials and Bioengineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasushi Shimada
- Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shohei Kasugai
- Department of Oral Implantology and Regenerative Dental Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Dental Clinic, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Eriko Marukawa
- Department of Regenerative and Reconstructive Dental Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Bettle G, Bell DP, Bakewell SJ. A Novel Comprehensive Therapeutic Approach to the Challenges of Chronic Wounds: A Brief Review and Clinical Experience Report. Adv Ther 2024; 41:492-508. [PMID: 38104037 PMCID: PMC10838851 DOI: 10.1007/s12325-023-02742-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023]
Abstract
Following the clinical perspective and concept that a healthy body will not develop chronic wounds, the central approach for the treatment described here is based on an understanding of how the body transforms the wound microenvironment from a non-healing to a healing state. As part of a comprehensive treatment regimen that includes OCM™ (complete matrix), wound preparation, and skin protectant formulations, the OCM contains components for complete wound healing by attending to the individual needs required to promote the closure of each unique chronic wound. During application of the comprehensive treatment regimen in independent investigator-led trials, the total wound percentage average reduction over the first 4 weeks of treatment was 60% across multiple wound types; median time to total wound closure was 6.9 weeks. Safety testing of the OCM formulation shows no potential allergenicity, no potential sensitization, and no known product-related adverse events. Clinical trials evaluating the OCM formulation as part of the comprehensive treatment regimen of multiple wound types are underway. Results of clinical trials and real-world experiences will expand current knowledge of the wound-healing potential of this novel product.
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Affiliation(s)
- Griscom Bettle
- Department of Clinical Research and Development, Omeza, LLC, 1610 Northgate Boulevard, Sarasota, FL, 34234, USA
| | - Desmond P Bell
- Department of Clinical Research and Development, Omeza, LLC, 1610 Northgate Boulevard, Sarasota, FL, 34234, USA
| | - Suzanne J Bakewell
- Department of Clinical Research and Development, Omeza, LLC, 1610 Northgate Boulevard, Sarasota, FL, 34234, USA.
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Donnelly P, Soares R, Eynon A, Grundy P, Durnford A. Animal products in neurosurgery - navigating informed consent. Br J Neurosurg 2023:1-4. [PMID: 37735919 DOI: 10.1080/02688697.2023.2256875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
Informed consent is an ethical and legal requirement integral to modern surgical practice. Clinicians have a duty to consider, disclose and discuss risks and concerns relevant to an individual patient. With medical advances there are now a significant number of animal-derived products and adjuncts available for use in modern neurosurgical practice, which may be relevant when consenting patients for specific procedures if such products are used. This paper highlights commonly used products in neurosurgery that contain animal-derived constituents with the aim of facilitating an informed discussion between the neurosurgeon and patient. We have reviewed the commonly used products in the centres of the authors and their commercial equivalents. The product information is taken from the manufacturer's instructions or the Federal Drug Administration documents regarding the product. Animal products commonly available to neurosurgeons can be broadly categorised into haemostatic agents, dural substitutes, dural sealants and bone cements. Many products contain a variety of animal (or human) derived products. In order to ensure informed consent and shared decision making, it is important to establish any relevant patient beliefs or views regarding the use of animal-derived products. Given the wide availability and use of neurosurgical adjuncts containing human or animal derived products, coupled with the heterogeneity within ethnic, religious, and social groups, each patient must be approached individually to ensure patient-specific concerns are identified and alternatives offered when appropriate.
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Affiliation(s)
- Patrick Donnelly
- Department of Neurosurgery, Mater Hospital Brisbane, South Brisbane, Queensland, Australia
| | - Rui Soares
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Andy Eynon
- University Hospital Southampton, Southampton, UK
| | - Paul Grundy
- University Hospital Southampton, Southampton, UK
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Silk G, Vetharajan N, Blohm A, Teeling F, Keen K, Sullivan N, Kiran M. Are vegans being overlooked in our prescribing practices: An orthopaedic perspective from Bristol, United Kingdom. J Clin Orthop Trauma 2023; 44:102250. [PMID: 37817761 PMCID: PMC10561050 DOI: 10.1016/j.jcot.2023.102250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/30/2023] [Accepted: 09/21/2023] [Indexed: 10/12/2023] Open
Abstract
Aim Bristol is considered the vegan capital of the UK. The UK vegan index reveals that Bristol has 360,000 Google searches each month for Vegan content. However, the possible animal source of the medications we prescribe is not commonly contemplated. Medications in the UK must pass through animal trials prior to licensing and therefore cannot be vegan. There are, alternatives available for some medications, that do not contain animal products. The aim of this study is to review the presence of content of animal origin (CAO) in common medicines in Trauma and Orthopaedics (T&O) and explore alternatives. Methods We evaluated the presence and source of CAO in commonly used medications in T&O practice. The British National Formulary (BNF), our local pharmacy guidelines and the online Summary of Product Characteristics (SPCs) for the medications were reviewed. We also assessed the suitability of current COVID-19 vaccines for patients who have reservations against CAO. Results All unfractionated or standard heparin is porcine in origin; Fondaparinux is a simple alternative. Cholecalciferol (vitamin D3) manufacture involves the use of lanolin from sheep's wool. Vitamin D2 (ergocalciferol) is an alternative with no CAO. All widely available Covid-19 vaccines in the UK are suitable for administration to vegans and all religious faiths. Propofol, widely used as an anaesthetic agent, contains egg proteins. Conclusion Disclosure of animal content would help patients make informed choices. With an increasingly informed population and ethnic diversity, we should be aware of the drugs that may contain animal products so that we can offer alternatives. Sometimes, pharmaceutical companies cannot guarantee or differentiate the specific sources of animal-derived ingredients, as various suppliers are used in the manufacturing process and the sources can change on a regular basis. Patients are more likely to adhere to prescribed medicines if they have been involved in prescribing decisions.
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Affiliation(s)
- Gwithyen Silk
- University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom
| | - Niraj Vetharajan
- University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom
| | - Alice Blohm
- University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom
| | - Fiona Teeling
- University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom
| | - Katie Keen
- University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom
| | - Niall Sullivan
- University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom
| | - Manish Kiran
- University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom
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Amundson JR, Kuchta K, Wu H, VanDruff VN, Haggerty SP, Linn J, Ujiki MB. A 13-year experience with biologic and biosynthetic absorbable mesh reinforced laparoscopic paraesophageal hernia repair. Surg Endosc 2023; 37:7271-7279. [PMID: 37407714 DOI: 10.1007/s00464-023-10248-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/23/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Mesh reinforced cruroplasty during laparoscopic paraesophageal hernia repair remains controversial due to wide variation in surgical technique and mesh composition. This study aims to review outcomes and rates of recurrence following laparoscopic paraesophageal hernia repair (LPEHR) with mesh reinforced cruroplasty utilizing absorbable mesh at a single institution. METHODS A retrospective review of all patients who underwent LPEHR with mesh was performed. Medical records were reviewed for patient reported, radiographic or endoscopic evidence of recurrence, defined as > 2 cm of vertical intrathoracic stomach. If no studies were available for review, patients were considered to have no recurrence. Outcomes and mesh-related complications were also reviewed. RESULTS Between 10/2008 and 9/2021, 473 patients underwent LPEHR with absorbable mesh; 1.3% type 2 hernias, 86.0% type 3 hernias, 12.7% type 4 hernias. Three types of mesh were used: initially biologic mesh (n = 83), then heavyweight synthetic bioabsorbable mesh (n = 261), and finally lightweight synthetic bioabsorbable mesh (n = 111). There were no significant differences in age, ASA, BMI, gender, smoking status, chronic steroid use, preoperative acid suppression, hernia type, or recurrent hernia between groups. There were no significant differences in 30-day postoperative outcomes. Reflux Symptom Index, GERD-HRQL, and Dysphagia Scores at 1- and 2-year postoperative timepoints were not significantly different. The overall recurrence rate was 16.7%, with no significant differences in recurrence rates between biologic, heavyweight or lightweight biosynthetic absorbable mesh through 2 years after surgery. A shorter median time to recurrence (10 months, p = 0.016) was seen in the lightweight group. CONCLUSION LPEHR with absorbable mesh reinforced cruroplasty is feasible and safe, with equivalent patient-reported outcomes, including dysphagia, up to 2-years postop regardless of mesh choice. No significant differences in recurrence rates between biologic, heavyweight, or lightweight synthetic bioabsorbable mesh were seen up to 2 years after LPEHR.
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Affiliation(s)
- Julia R Amundson
- Department of Surgery, NorthShore University Health System, 2650 Ridge AveGCSI Suite B665, Evanston, IL, 60201, USA.
- Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA.
| | - Kristine Kuchta
- Department of Surgery, NorthShore University Health System, 2650 Ridge AveGCSI Suite B665, Evanston, IL, 60201, USA
| | - Hoover Wu
- Department of Surgery, NorthShore University Health System, 2650 Ridge AveGCSI Suite B665, Evanston, IL, 60201, USA
- Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Vanessa N VanDruff
- Department of Surgery, NorthShore University Health System, 2650 Ridge AveGCSI Suite B665, Evanston, IL, 60201, USA
- Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Stephen P Haggerty
- Department of Surgery, NorthShore University Health System, 2650 Ridge AveGCSI Suite B665, Evanston, IL, 60201, USA
| | - John Linn
- Department of Surgery, NorthShore University Health System, 2650 Ridge AveGCSI Suite B665, Evanston, IL, 60201, USA
| | - Michael B Ujiki
- Department of Surgery, NorthShore University Health System, 2650 Ridge AveGCSI Suite B665, Evanston, IL, 60201, USA
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Trangerud HA. "What is the problem with vaccines?" A typology of religious vaccine skepticism. Vaccine X 2023; 14:100349. [PMID: 37484867 PMCID: PMC10362305 DOI: 10.1016/j.jvacx.2023.100349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/30/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023] Open
Abstract
Research has identified religion as one of numerous factors that may contribute to delay or refusal of vaccination. The influence of religion on vaccine decisions may be accidental, or it may involve explicit religious objections. By presenting a typology of religious vaccine skepticism, this article seeks to give a comprehensive overview of the essence of these objections and to clarify differences and similarities between them. This knowledge is useful for policy-makers and others who wish to better understand the influence of religion on vaccine decision-making. The typology consists of five main types: (1) a worldview clash type, in which vaccines do not make sense as a health intervention; (2) a divine will type, which represents a form of passive fatalism; (3) an immorality type, which considers some vaccines unethical because of their production or effect; (4) an impurity type, pointing to ingredients that will defile the body; and (5) a conspiracy type, in which a vaccine plot is targeting a religious group.
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Chopra P, Singh M, Singh A, Masi A, Yurkofsky J, Zaita B, Kaur G. Perioperative Management of Spontaneous Intracranial Hemorrhage in a Patient With Hemophilia A in a Resource Limited Country. Cureus 2023; 15:e43485. [PMID: 37711951 PMCID: PMC10499499 DOI: 10.7759/cureus.43485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 09/16/2023] Open
Abstract
Intracranial hemorrhage (ICH) is a serious complication of hemophilia A with high morbidity and mortality. The management of such cases is complicated by nonspecific and often delayed presentation, increased frequency of rebleeding, low awareness regarding clotting factor replacement, and debate regarding the efficacy of surgical interventions. We report a case of an 18-year-old male patient with hemophilia A, who first presented to the emergency department in India in a comatose state. Neuroimaging revealed subdural hematoma with midline shift and uncal herniation. The patient was successfully managed with perioperative cryoprecipitate and factor VIII replacement, tiered intracranial pressure lowering strategies, and early decompressive craniectomy with clot evacuation. In India, there are no standardized guidelines for screening and routine care for hereditary diseases like hemophilia. In a resource-deficient country, management was complicated by the limited availability of factor VIII in the emergent setting, as well as the inability to obtain serial factor levels in the postoperative period. We hope that this article helps to guide the management of ICH and hemophilia in resource-limited countries.
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Affiliation(s)
- Puneet Chopra
- Critical Care, Satguru Partap Singh (SPS) Hospital, Ludhiana, IND
| | - Manraj Singh
- Basic Biomedical Sciences, Dayanand Medical College and Hospital, Ludhiana, IND
| | | | - Athena Masi
- Basic Biomedical Sciences, Touro College of Osteopathic Medicine, Middletown, USA
| | - Judith Yurkofsky
- Basic Biomedical Sciences, Touro College of Osteopathic Medicine, Middletown, USA
| | - Brittany Zaita
- Basic Biomedical Sciences, Touro College of Osteopathic Medicine, Middletown, USA
| | - Gurjinder Kaur
- Basic Biomedical Sciences, Touro College of Osteopathic Medicine, Middletown, USA
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Nourian MM, Stone CA, Siegrist KK, Riess ML. Perioperative implications of patients with alpha gal allergies. J Clin Anesth 2023; 86:111056. [PMID: 36682226 PMCID: PMC11087933 DOI: 10.1016/j.jclinane.2023.111056] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/14/2022] [Accepted: 01/15/2023] [Indexed: 01/21/2023]
Abstract
Alpha Gal Syndrome (AGS) is an emerging immune response to mammalian products (MP) containing the oligosaccharide galactose-α-1,3 galactose (α-Gal) which includes meats and inactive ingredients in certain medications. This becomes clinically important in the perioperative realm as MPs are commonly found in the operating room, and pre- and post-operative settings, and can trigger responses as severe as anaphylaxis. In this review, authors discuss the epidemiology, diagnosis and treatment of AGS reactions. Additionally, strategies are explored in order to screen and prevent exposure to MP with a multidisciplinary approach. While this emerging allergy is still not fully understood, it is of paramount importance that all anesthesia providers recognize the implications of MP exposure in AGS patients and ultimately prevent harm in this highly vulnerable population.
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Affiliation(s)
- Maziar M Nourian
- Department of Anesthesiology, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN 37232, USA.
| | - Cosby A Stone
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA.
| | - Kara K Siegrist
- Department of Anesthesiology, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN 37232, USA.
| | - Matthias L Riess
- Department of Anesthesiology, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN 37232, USA; Anesthesiology, Tennessee Valley Healthcare System Veterans Affairs Medical Center, 1310 24(th) Ave South, Nashville, TN 37212, USA; Department of Pharmacology, Vanderbilt University, 465 21(st) Avenue South, Nashville, TN 37232, USA.
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Hasan MR, Tabassum T, Tabassum T, Tanbir MA, Kibria M, Chowduary M, Nambiar R. Navigating Cultural Diversity in the Selection of Cardiovascular Device Treatments: A Comprehensive Review. Cureus 2023; 15:e38934. [PMID: 37313070 PMCID: PMC10259755 DOI: 10.7759/cureus.38934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/15/2023] Open
Abstract
In cardiology, patients' cultural beliefs, linguistic differences, lack of knowledge, and socioeconomic status can create barriers to choosing device treatment. To address this issue, we conducted a thorough literature review using online databases such as PubMed, Google Scholar, and Texas Tech University Health Sciences Center's research portal. Our review found that cultural, religious, and linguistic barriers can contribute to patients' apprehension and reservations about device placement. These barriers can also impact patients' adherence to treatment and clinical outcomes. Patients from lower socioeconomic backgrounds may have difficulty accessing and affording device-based treatments. Additionally, fear and inadequate understanding of surgical procedures can deter patients from accepting device treatment in cardiology. To overcome these cultural barriers, healthcare providers must raise awareness about the benefits of device treatment and provide better training to overcome these challenges. It is crucial to address the unique needs of patients from different cultural backgrounds and socioeconomic statuses to ensure they receive the care they need.
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Affiliation(s)
- Md Rockyb Hasan
- Department of Internal Medicine, Amarillo Campus, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Tahsin Tabassum
- Department of Public Health, School of Community Health and Policy, Morgan State University, Baltimore, USA
| | - Tanzin Tabassum
- Department of General Surgery, West Suffolk Hospital, Bury St Edmunds, GBR
| | - Mohammed A Tanbir
- Department of Internal Medicine, Amarillo Campus, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Mahzabin Kibria
- Department of Medicine, Sir Salimullah Medical College, Dhaka, BGD
| | - Mahidul Chowduary
- Department of Internal Medicine, Interfaith Medical Center, Brooklyn, USA
| | - Rajesh Nambiar
- Department of Cardiology, Amarillo Campus, Texas Tech University Health Sciences Center, Amarillo, USA
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12
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Bokek-Cohen Y. The Need to Adjust the Informed Consent for Jewish Patients for Treatments Involving Porcine Medical Constituents. J Immigr Minor Health 2023; 25:142-150. [PMID: 35849274 DOI: 10.1007/s10903-022-01383-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 01/07/2023]
Abstract
In order to obtain full informed consent for medical treatments, it is imperative to provide patients of diverse ethnic backgrounds with all relevant information. Since the pig is considered an impure animal in Judaism, Jewish patients may wish to be informed of porcine-derived substances used in treating. The present study is the first to explore the level of knowledge of Jewish participants as to whether the medical use of pig is permitted by their religion, and the extent to which they believe it should be permitted. 714 Jewish participants completed a study questionnaire that included 15 medical uses of pigs. Findings indicated that the knowledge of Jewish law regarding these uses is a significant mediator in predicting the attitude toward the permissibility of these uses. I conclude with practical recommendations as to how to enhance cultural competence and improve the informed consent process when treating Jewish patients with porcine-derived constituents.
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Affiliation(s)
- Ya'arit Bokek-Cohen
- School of Nursing, The Israel Academic College of Ramat Gan, 87 Ruttenberg St., 5227528, Ramat Gan, Israel. .,School of Nursing, The Academic College of Tel Aviv Jaffa, 10 Hever HaLe'umim St, 7475588, Tel Aviv, Israel.
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13
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Alves AL, Carvalho AC, Machado I, Diogo GS, Fernandes EM, Castro VIB, Pires RA, Vázquez JA, Pérez-Martín RI, Alaminos M, Reis RL, Silva TH. Cell-Laden Marine Gelatin Methacryloyl Hydrogels Enriched with Ascorbic Acid for Corneal Stroma Regeneration. BIOENGINEERING (BASEL, SWITZERLAND) 2023; 10:bioengineering10010062. [PMID: 36671634 PMCID: PMC9854711 DOI: 10.3390/bioengineering10010062] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
Corneal pathologies from infectious or noninfectious origin have a significant impact on the daily lives of millions of people worldwide. Despite the risk of organ rejection or infection, corneal transplantation is currently the only effective treatment. Finding safe and innovative strategies is the main goal of tissue-engineering-based approaches. In this study, the potential of gelatin methacryloyl (GelMA) hydrogels produced from marine-derived gelatin and loaded with ascorbic acid (as an enhancer of the biological activity of cells) was evaluated for corneal stromal applications. Marine GelMA was synthesized with a methacrylation degree of 75%, enabling effective photocrosslinking, and hydrogels with or without ascorbic acid were produced, encompassing human keratocytes. All the produced formulations exhibited excellent optical and swelling properties with easy handling as well as structural stability and adequate degradation rates that may allow proper extracellular matrix remodeling by corneal stromal cells. Formulations loaded with 0.5 mg/mL of ascorbic acid enhanced the biological performance of keratocytes and induced collagen production. These results suggest that, in addition to marine-derived gelatin being suitable for the synthesis of GelMA, the hydrogels produced are promising biomaterials for corneal regeneration applications.
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Affiliation(s)
- Ana L. Alves
- 3B’s Research Group, i3B’s—Research Institute on Biomaterials, Bisodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Guimarães, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4806-909 Braga/Guimarães, Portugal
| | - Ana C. Carvalho
- 3B’s Research Group, i3B’s—Research Institute on Biomaterials, Bisodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Guimarães, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4806-909 Braga/Guimarães, Portugal
| | - Inês Machado
- 3B’s Research Group, i3B’s—Research Institute on Biomaterials, Bisodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Guimarães, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4806-909 Braga/Guimarães, Portugal
| | - Gabriela S. Diogo
- 3B’s Research Group, i3B’s—Research Institute on Biomaterials, Bisodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Guimarães, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4806-909 Braga/Guimarães, Portugal
| | - Emanuel M. Fernandes
- 3B’s Research Group, i3B’s—Research Institute on Biomaterials, Bisodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Guimarães, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4806-909 Braga/Guimarães, Portugal
| | - Vânia I. B. Castro
- 3B’s Research Group, i3B’s—Research Institute on Biomaterials, Bisodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Guimarães, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4806-909 Braga/Guimarães, Portugal
| | - Ricardo A. Pires
- 3B’s Research Group, i3B’s—Research Institute on Biomaterials, Bisodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Guimarães, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4806-909 Braga/Guimarães, Portugal
| | - José A. Vázquez
- Group of Recycling and Valorization of Waste Materials (REVAL), Instituto de Investigaciones Marinas (IIM-CSIC), C/Eduardo Cabello 6, CP36208 Vigo, Spain
| | - Ricardo I. Pérez-Martín
- Group of Food Biochemistry, Instituto de Investigaciones Marinas (IIM-CSIC), C/Eduardo Cabello 6, CP36208 Vigo, Spain
| | - Miguel Alaminos
- Department of Histology and Tissue Engineering Group, Faculty of Medicine, University of Granada and Instituto de Investigación Biosanitaria (ibs.GRANADA), E18016 Granada, Spain
| | - Rui L. Reis
- 3B’s Research Group, i3B’s—Research Institute on Biomaterials, Bisodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Guimarães, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4806-909 Braga/Guimarães, Portugal
| | - Tiago H. Silva
- 3B’s Research Group, i3B’s—Research Institute on Biomaterials, Bisodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Guimarães, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4806-909 Braga/Guimarães, Portugal
- Correspondence:
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Martin EA, Chauhan N, Dhevan V, George E, Laskar P, Jaggi M, Chauhan SC, Yallapu MM. Current status of biopsy markers for the breast in clinical settings. Expert Rev Med Devices 2022; 19:965-975. [PMID: 36524747 DOI: 10.1080/17434440.2022.2159807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION A breast biopsy marker is a very small object that is introduced into the breast to serve as a tissue marker. The placement of a breast marker following a biopsy or to mark an abnormality in the breast has become standard practice in the clinical setting. Breast biopsy markers offer a wide range of benefits which includes the prevention of re-biopsy of a benign tumor, differentiating multiple lesions within the breast, evaluation of the extent of a tumor, and increased precision during surgery. AREAS COVERED This review article presents a range of breast biopsy markers used in clinical practice. First, an overview of the necessity of breast markers in healthy breast management. Second, it summarizes the diversity in composition, shape, unique properties and features, and bio-absorbable carriers of breast biopsy markers. Finally, it also discusses the possible use of clinically approved breast biopsy markers in various scenarios and their implications. EXPERT OPINION This review serves as a guide in the selection of an appropriate breast marker. We believe that some of the common drawbacks associated with current breast biopsy markers can be overcome by developing novel polymer-metal and composite-based breast biopsy markers.
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Affiliation(s)
- Elian A Martin
- Department of Immunology and Microbiology, School of Medicine, The University of Texas Rio Grande Valley, McAllen, Texas, USA
| | - Neeraj Chauhan
- Department of Immunology and Microbiology, School of Medicine, The University of Texas Rio Grande Valley, McAllen, Texas, USA.,South Texas Center of Excellence in Cancer Research, School of Medicine, The University of Texas Rio Grande Valley, McAllen, Texas, USA
| | - Vijian Dhevan
- Department of Surgery, the University of Texas Rio Grande Valley, Edinburg, Texas, USA.,Department of Surgery, Valley Baptist Medical Center, Harlingen, Texas, USA
| | - Elias George
- Department of Immunology and Microbiology, School of Medicine, The University of Texas Rio Grande Valley, McAllen, Texas, USA.,South Texas Center of Excellence in Cancer Research, School of Medicine, The University of Texas Rio Grande Valley, McAllen, Texas, USA
| | - Partha Laskar
- Department of Immunology and Microbiology, School of Medicine, The University of Texas Rio Grande Valley, McAllen, Texas, USA.,South Texas Center of Excellence in Cancer Research, School of Medicine, The University of Texas Rio Grande Valley, McAllen, Texas, USA
| | - Meena Jaggi
- Department of Immunology and Microbiology, School of Medicine, The University of Texas Rio Grande Valley, McAllen, Texas, USA.,South Texas Center of Excellence in Cancer Research, School of Medicine, The University of Texas Rio Grande Valley, McAllen, Texas, USA
| | - Subhash C Chauhan
- Department of Immunology and Microbiology, School of Medicine, The University of Texas Rio Grande Valley, McAllen, Texas, USA.,South Texas Center of Excellence in Cancer Research, School of Medicine, The University of Texas Rio Grande Valley, McAllen, Texas, USA
| | - Murali M Yallapu
- Department of Immunology and Microbiology, School of Medicine, The University of Texas Rio Grande Valley, McAllen, Texas, USA.,South Texas Center of Excellence in Cancer Research, School of Medicine, The University of Texas Rio Grande Valley, McAllen, Texas, USA
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15
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Bokek-Cohen Y, Tarabeih M. The Use of Porcine-Derived Materials for Medical Purposes: What do Muslim and Jewish Individuals Know and Opine About It? JOURNAL OF BIOETHICAL INQUIRY 2022; 19:599-612. [PMID: 36063344 DOI: 10.1007/s11673-022-10203-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/10/2022] [Indexed: 06/15/2023]
Abstract
Porcine-derived medical products represent an effective solution for a wide range of human suffering, yet this may contradict Muslim and Jewish religious prohibitions against consuming pig. The present study evaluated the level to which Muslim and Jewish participants are knowledgeable about the conditions permitting porcine-based treatments and explored their attitudes toward the permissibility of these treatments. A questionnaire that presented fifteen medical uses of porcine-derived products was completed by 809 Muslims and 714 Jews. Neither Muslim nor Jewish participants are knowledgeable about the religious rulings of their religions which permit the use of pig for life saving. Participants of both groups objected to the view that porcine-derived materials should be permitted. The findings imply that the attitude toward porcine-derived materials for medical use is contingent upon the knowledge or lack thereof that individuals have regarding the permissibility of such use. We offer useful recommendations to improve the informed consent process before conducting porcine-based treatments.
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Affiliation(s)
- Ya'arit Bokek-Cohen
- School of Social Sciences, Academic College of Israel in Ramat-Gan, 87 Ruttenberg St., Postal code 5227528, Ramat-Gan, Israel.
- , Holon, Israel.
| | - Mahdi Tarabeih
- School of Nursing, 2 Rabenu Yerucham St., Postal code 6161001, Tel Aviv, Israel
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Assari A, Hani M, Qaid H, Omar B, Aleid L. Effect of religious beliefs on bone graft selection for oral and maxillofacial surgery in Saudi Arabia. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e563-e568. [DOI: 10.1016/j.jormas.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/19/2022] [Accepted: 01/28/2022] [Indexed: 04/08/2023]
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17
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Muhamad N, Abu MA, Kalok AH, Shafiee MN, Shah SA, Ismail NAM. Safety and effectiveness of fondaparinux as a postpartum thromboprophylaxis during puerperium among muslim women: A single centre prospective study. Front Pharmacol 2022; 13:887020. [PMID: 36210844 PMCID: PMC9540499 DOI: 10.3389/fphar.2022.887020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Venous thromboembolism (VTE) remains one of the leading causes of maternal morbidity and mortality, with postpartum period carrying the greatest risk. Perinatal thromboprophylaxis is often administered based on risk-factor assessment. Low molecular weight heparin has a proven safety profile in the obstetrics population, however, its porcine-derived content may lead to reduced uptake amongst certain religious groups. We aimed to evaluate the safety of fondaparinux as an alternative postpartum thromboprophylaxis. Methods: We conducted a prospective, single arm, open label study from September 2017 until March 2018. Women who fulfilled the criteria for post natal thromboprophylaxis based on the 2015 RCOG guidelines were recruited. Each patient received subcutaneous injection of Fondaparinux, 2.5 mg daily for 10 days. A telephone interview was conducted on day 10 post delivery. Each woman was subsequently reviewed in the outpatient clinic 6 weeks postpartum. The primary outcome measure was occurrence of pulmonary embolism or deep vein thrombosis suggestive by clinical symptoms and assessment. Secondary outcome measures were allergic reaction and bleeding tendency such as secondary post-partum haemorrhage, spinal site bleeding and wound haematoma. Allergic reaction and bleeding tendency in neonates were also recorded. Results: Sixty women were included in the analysis. There were no VTE cases amongst our cohort. No major bleeding was recorded. Two patients (3.3%) had wound haematoma, one of which occurred 3 weeks post delivery. No adverse effect in neonates was noted. Conclusion: Fondaparinux is a safe alternative thromboprophylaxis for postpartum women.
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Affiliation(s)
- Normaliza Muhamad
- Department of Obstetrics and Gynecology, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Muhammad Azrai Abu
- Department of Obstetrics and Gynecology, UKM Medical Centre, Kuala Lumpur, Malaysia
- *Correspondence: Muhammad Azrai Abu,
| | - Aida Hani Kalok
- Department of Obstetrics and Gynecology, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd Nasir Shafiee
- Department of Obstetrics and Gynecology, UKM Medical Centre, Kuala Lumpur, Malaysia
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Karlsson M, Elmasry M, Steinvall I, Huss F, Olofsson P, Elawa S, Larsson A, Sjöberg F. Biosynthetic cellulose compared to porcine xenograft in the treatment of partial-thickness burns: A randomised clinical trial. Burns 2022; 48:1236-1245. [PMID: 34629186 DOI: 10.1016/j.burns.2021.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/15/2022]
Abstract
AIM The aim was to compare two dressing treatments for partial-thickness burns: biosynthetic cellulose dressing (BsC) (Epiprotect® S2Medical AB, Linköping, Sweden) and porcine xenograft (EZ Derm®, Mölnlycke Health Care, Gothenburg, Sweden). METHODS Twenty-four adults with partial-thickness burns were included in this randomized clinical trial conducted at The Burn Centers in Linköping and Uppsala, Sweden between June 2016 and November 2018. Time to healing was the primary outcome. Secondary outcomes were wound infection, pain, impact on everyday life, length of hospital stay, cost, and burn scar outcome (evaluated with POSAS). RESULTS We found no significant differences between the two dressing groups regarding time to healing, wound infection, pain, impact on everyday life, duration of hospital stay, cost, or burn scar outcome at the first follow up. Burn scar outcome at the 12-month follow up showed that the porcine xenograft group patients scored their scars higher on the POSAS items thickness (p = 0.048) and relief (p = 0.050). This difference was, however, not confirmed by the observer. CONCLUSIONS The results showed the dressings performed similarly when used in adults with burns evaluated as partial thickness.
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Affiliation(s)
- Matilda Karlsson
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Moustafa Elmasry
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ingrid Steinvall
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Fredrik Huss
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden; Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Pia Olofsson
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sherif Elawa
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Alexander Larsson
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Folke Sjöberg
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Anesthesiology and Intensive Care, Linköping University, Linköping, Sweden
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Exploring Muslims' Health-Related Behaviours in Portugal: Any Impact on Quotidian Community Pharmacy Practice? PHARMACY 2022; 10:pharmacy10030055. [PMID: 35645334 PMCID: PMC9150020 DOI: 10.3390/pharmacy10030055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/11/2022] [Accepted: 05/19/2022] [Indexed: 12/02/2022] Open
Abstract
Muslims are a growing community in European countries. General health habits, including therapy-related behaviours, have been described, though implications to pharmacy practice might vary with the local dominant culture and setting. This exploratory study aimed to describe Muslims’ prevalent health and medication-related practices and possible implications for culturally competent community pharmacy practice. A descriptive cross-sectional survey was administered to a convenient sample of 100 participants at Lisbon Central Mosque, Portugal. Demographics, dietary, Traditional Arabic and Islamic Medicine (TAIM) and religious practices were examined, including health conditions and conventional biomedical treatments. Participant reported ailments (26%) were aligned with prevalent conditions in the general population. Ill participants were significantly associated with TAIM and Islamic dictates (p < 0.05), particularly Zam-Zam water and milk thistle usage. Participants’ orientation to dietary options and Qur’an restrictions were observed regarding forbidden substances in medication, raising issues on medication adherence for some oral dosage forms. TAIM and religious beliefs supplement illness recovery and health improvement instead of replacing conventional healthcare in a religious minority well integrated within the dominant culture. Portuguese community pharmacists should not neglect religious specificities if seamless care is delivered, enhancing professionals’ collaboration skills with multicultural patients.
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Ali K, Gupta P, Turay E, Burns L, Brookes Z, Raja M. Dentistry in a multicultural society: the impact of animal-based products on person-centred care. Br Dent J 2022; 232:269-272. [PMID: 35217748 DOI: 10.1038/s41415-022-3982-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/22/2021] [Indexed: 11/09/2022]
Abstract
Cultural competence of healthcare professionals requires a combination of awareness, knowledge and skills to provide healthcare services to culturally and lingually diverse populations. The aim of this paper is to raise awareness regarding animal-based constituents in dental products which may not be acceptable to patients from different cultural, spiritual, or religious backgrounds. Animal-based products are used widely in medicine and dentistry. However, patients and sometimes even dental professionals may not be aware of this. This paper identifies some common products used in clinical dentistry which are derived from animal-based sources and discusses the implications of their use in a multicultural society.
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Affiliation(s)
- Kamran Ali
- Qatar University, College of Dental Medicine, QU Health, Doha 2713, Qatar.
| | - Pooja Gupta
- Plymouth University, Faculty of Health, Plymouth, PL4 8AA, Devon, UK
| | - Emma Turay
- Plymouth University, Faculty of Health, Plymouth, PL4 8AA, Devon, UK
| | - Lorna Burns
- Plymouth University, Faculty of Health, Plymouth, PL4 8AA, Devon, UK
| | - Zoe Brookes
- Plymouth University, Faculty of Health, Plymouth, PL4 8AA, Devon, UK
| | - Mahwish Raja
- Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
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21
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Gill S, Prakash M, Forghany M, Vaderhobli RM. An ethical perspective to using bone grafts in dentistry. J Am Dent Assoc 2022; 153:88-91. [PMID: 34996535 DOI: 10.1016/j.adaj.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 01/15/2023]
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22
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Petrie K, Cox CT, Becker BC, MacKay BJ. Clinical applications of acellular dermal matrices: A review. Scars Burn Heal 2022; 8:20595131211038313. [PMID: 35083065 PMCID: PMC8785275 DOI: 10.1177/20595131211038313] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The extracellular matrix (ECM) plays an integral role in wound healing. It provides both structure and growth factors that allow for the organised cell proliferation. Large or complex tissue defects may compromise host ECM, creating an environment that is unfavourable for the recovery of anatomical function and appearance. Acellular dermal matrices (ADMs) have been developed from a variety of sources, including human (HADM), porcine (PADM) and bovine (BADM), with multiple different processing protocols. The objective of this report is to provide an overview of current literature assessing the clinical utility of ADMs across a broad spectrum of applications. METHODS PubMed, MEDLINE, EMBASE, Scopus, Cochrane and Web of Science were searched using keywords 'acellular dermal matrix', 'acellular dermal matrices' and brand names for commercially available ADMs. Our search was limited to English language articles published from 1999 to 2020 and focused on clinical data. RESULTS A total of 2443 records underwent screening. After removing non-clinical studies and correspondence, 222 were assessed for eligibility. Of these, 170 were included in our synthesis of the literature. While the earliest ADMs were used in severe burn injuries, usage has expanded to a number of surgical subspecialties and procedures, including orthopaedic surgery (e.g. tendon and ligament reconstructions), otolaryngology, oral surgery (e.g. treating gingival recession), abdominal wall surgery (e.g. hernia repair), plastic surgery (e.g. breast reconstruction and penile augmentation), and chronic wounds (e.g. diabetic ulcers). CONCLUSION Our understanding of ADM's clinical utility continues to evolve. More research is needed to determine which ADM has the best outcomes for each clinical scenario. LAY SUMMARY Large or complex wounds present unique reconstructive and healing challenges. In normal healing, the extracellular matrix (ECM) provides both structural and growth factors that allow tissue to regenerate in an organised fashion to close the wound. In difficult or large soft-tissue defects, however, the ECM is often compromised. Acellular dermal matrix (ADM) products have been developed to mimic the benefits of host ECM, allowing for improved outcomes in a variety of clinical scenarios. This review summarises the current clinical evidence regarding commercially available ADMs in a wide variety of clinical contexts.
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Affiliation(s)
- Kyla Petrie
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Cameron T Cox
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - Brendan J MacKay
- Texas Tech University Health Sciences Center, Lubbock, TX, USA.,University Medical Center, Lubbock, TX, USA
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Bhamra N, Jolly K, Darr A, Bowyer DJ, Ahmed SK. Intra-operative use of biological products-Are we aware of their derivatives? Int J Clin Pract 2021; 75:e14633. [PMID: 34270848 DOI: 10.1111/ijcp.14633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Global medical advances within healthcare have subsequently led to the widespread introduction of biological products such as grafts, haemostats, and sealants. Although these products have been used for many decades, this subject is frequently not discussed during the consent process and remains an area of contention. METHODS A nationwide confidential online survey was distributed to UK-based junior registrars (ST3-5), senior registrars (ST6-8), post-CCT fellows, specialist associates/staff grade doctors and consultants working in general/vascular surgery, neurosurgery, otolaryngology, oral and maxillofacial surgery and plastic surgery. RESULTS Data were collected from a total of 308 survey respondents. Biological derivatives were correctly identified in surgical products by only 25% of survey respondents, only 19% stated that they regularly consent for use of these products. Our results demonstrate that most participants in this study do not routinely consent (81%) to the intra-operative use of biological materials. An overwhelming 74% of participants agreed that further education on the intra-operative use of biological materials would be valuable. DISCUSSION This study highlights deficiencies in knowledge that results in potential compromise of the consenting process for surgical procedures. A solution to this would be for clinicians to increase their awareness via educational platforms and to incorporate an additional statement on the consent form which addresses the potential intraoperative use of biological products and what their derivatives may be. CONCLUSION Modernising the current consent process to reflect the development and use of surgical biological products will help to ensure improved patient satisfaction, fewer future legal implications as well as a better surgeon-patient relationship.
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Affiliation(s)
- Navdeep Bhamra
- Department of Otolaryngology, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Karan Jolly
- Department of Otolaryngology, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Adnan Darr
- Department of Otolaryngology, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Duncan J Bowyer
- Department of Otolaryngology, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Shahzada K Ahmed
- Department of Otolaryngology, University Hospitals Birmingham NHS Trust, Birmingham, UK
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Khalaf ME, Abubakr NH, Alenezi HM, Ziada HM. Patients' Perspectives of Grafting Materials in Implant Dentistry: A Qualitative Analysis. J Int Soc Prev Community Dent 2021; 11:428-436. [PMID: 34430505 PMCID: PMC8352050 DOI: 10.4103/jispcd.jispcd_82_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/04/2021] [Accepted: 04/24/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS The aim of this study was to evaluate the cultural, psychological, and religious influences on the choice of autografts, allografts, xenografts, and synthetic bone products for the grafting procedure and with implant placement. MATERIALS AND METHODS A qualitative methodology was employed, using the principles of the constant comparative method of the grounded theory; to investigate how people perceive and understand their experiences regarding the graft materials in implant dentistry. The data were collected using detailed qualitative interviews, till saturation was achieved, from 10 patients. RESULTS The three main themes that emerged in the analysis were: (a) grafting material preference, (b) religious and psychological influences, and (c) trust the doctor and cost influences. The three themes that emerged seemed to be interrelated. There were many statements of preference or rejection of choice based on religious, cultural, and psychological influences. CONCLUSIONS Within the limitations of this study, three themes emerged and they indicated that the influence on the grafting material's choice is unique to every individual; it also shares similarities, based on common religious and cultural values.
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Affiliation(s)
- Mai E Khalaf
- Department of General Dental Practice, Faculty of Dentistry, Kuwait University, Kuwait
| | - Neamat H Abubakr
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, NV, USA
| | - Hanadi M Alenezi
- Department of General Dental Practice, Faculty of Dentistry, Kuwait University, Kuwait
| | - Hassan M Ziada
- Department of Clinical Dental Sciences, School of Dental Medicine, University of Nevada, Las Vegas, NV, USA
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Rodger D. Why we should stop using animal-derived products on patients without their consent. JOURNAL OF MEDICAL ETHICS 2021; 48:medethics-2021-107371. [PMID: 34103364 DOI: 10.1136/medethics-2021-107371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/14/2021] [Indexed: 06/12/2023]
Abstract
Medicines and medical devices containing animal-derived ingredients are frequently used on patients without their informed consent, despite a significant proportion of patients wanting to know if an animal-derived product is going to be used in their care. Here, I outline three arguments for why this practice is wrong. First, I argue that using animal-derived medical products on patients without their informed consent undermines respect for their autonomy. Second, it risks causing nontrivial psychological harm. Third, it is morally inconsistent to respect patients' dietary preferences and then use animal-derived medicines or medical devices on them without their informed consent. I then address several anticipated objections and conclude that the continued failure to address this issue is an ethical blind spot that warrants applying the principles of respect for autonomy and informed consent consistently.
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Affiliation(s)
- Daniel Rodger
- Institute of Health and Social Care, London South Bank University, School of Allied and Community Health, London SE1 0AA, UK
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Brummett AL. Secular Clinical Ethicists Should Not Be Neutral Toward All Religious Beliefs: An Argument for a Moral-Metaphysical Proceduralism. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:5-16. [PMID: 33372859 DOI: 10.1080/15265161.2020.1863512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Secular clinical ethics has responded to the problem of moral pluralism with a procedural approach. However, defining this term stirs debate: H. Tristram Engelhardt Jr. has championed a contentless proceduralism (P1), while others, conversely, argue for a proceduralism that permits some content in the form of moral claims (P2). This paper argues that the content P2 permits ought to be expanded to include some metaphysical commitments, in an approach referred to as P2+. The need for P2+ is demonstrated by analyzing and rejecting three standards (the best interest or harm principle, internal reasonability, and the child's right to an open future) used by P2 to justify overriding religiously motivated refusals of treatment for children. These approaches fail because each maintains a neutral stance regarding the truth of religious belief. This paper drives at the broader thesis that the proceduralism of secular clinical ethics requires some moral and metaphysical commitments.
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Heinks T, Hettwer A, Hiepen C, Weise C, Gorka M, Knaus P, Mueller TD, Loidl-Stahlhofen A. Optimized expression and purification of a soluble BMP2 variant based on in-silico design. Protein Expr Purif 2021; 186:105918. [PMID: 34044133 DOI: 10.1016/j.pep.2021.105918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 04/11/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
Bone morphogenetic protein 2 (BMP21) is a highly interesting therapeutic growth factor due to its strong osteogenic/osteoinductive potential. However, its pronounced aggregation tendency renders recombinant and soluble production troublesome and complex. While prokaryotic expression systems can provide BMP2 in large amounts, the typically insoluble protein requires complex denaturation-renaturation procedures with medically hazardous reagents to obtain natively folded homodimeric BMP2. Based on a detailed aggregation analysis of wildtype BMP2, we designed a hydrophilic variant of BMP2 additionally containing an improved heparin binding site (BMP2-2Hep-7M). Consecutive optimization of BMP2-2Hep-7M expression and purification enabled production of soluble dimeric BMP2-2Hep-7M in high yield in E. coli. This was achieved by a) increasing protein hydrophilicity via introducing seven point mutations within aggregation hot spots of wildtype BMP2 and a longer N-terminus resulting in higher affinity for heparin, b) by employing E. coli strain SHuffle® T7, which enables the structurally essential disulfide-bond formation in BMP2 in the cytoplasm, c) by using BMP2 variant characteristic soluble expression conditions and application of l-arginine as solubility enhancer. The BMP2 variant BMP2-2Hep-7M shows strongly attenuated although not completely eliminated aggregation tendency.
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Affiliation(s)
- Tobias Heinks
- Westfälische Hochschule Recklinghausen, 45665, Recklinghausen, Germany.
| | - Anette Hettwer
- Westfälische Hochschule Recklinghausen, 45665, Recklinghausen, Germany; Universität Würzburg, Department for Molecular Plant Physiology and Biophysics - Botany I, Julius-von-Sachs Institute, 97082, Würzburg, Germany
| | - Christian Hiepen
- Freie Universität Berlin, Institute of Chemistry and Biochemistry, 14195, Berlin, Germany
| | - Christoph Weise
- Freie Universität Berlin, Institute of Chemistry and Biochemistry, 14195, Berlin, Germany
| | - Marcel Gorka
- Westfälische Hochschule Recklinghausen, 45665, Recklinghausen, Germany
| | - Petra Knaus
- Freie Universität Berlin, Institute of Chemistry and Biochemistry, 14195, Berlin, Germany
| | - Thomas D Mueller
- Universität Würzburg, Department for Molecular Plant Physiology and Biophysics - Botany I, Julius-von-Sachs Institute, 97082, Würzburg, Germany
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Haller HL, Blome-Eberwein SE, Branski LK, Carson JS, Crombie RE, Hickerson WL, Kamolz LP, King BT, Nischwitz SP, Popp D, Shupp JW, Wolf SE. Porcine Xenograft and Epidermal Fully Synthetic Skin Substitutes in the Treatment of Partial-Thickness Burns: A Literature Review. ACTA ACUST UNITED AC 2021; 57:medicina57050432. [PMID: 33946298 PMCID: PMC8146423 DOI: 10.3390/medicina57050432] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Porcine xenografts have been used successfully in partial thickness burn treatment for many years. Their disappearance from the market led to the search for effective and efficient alternatives. In this article, we examine the synthetic epidermal skin substitute Suprathel® as a substitute in the treatment of partial thickness burns. Materials and Methods: A systematic review following the PRISMA guidelines has been performed. Sixteen Suprathel® and 12 porcine xenograft studies could be included. Advantages and disadvantages between the treatments and the studies’ primary endpoints have been investigated qualitatively and quantitatively. Results: Although Suprathel had a nearly six times larger TBSA in their studies (p < 0.001), it showed a significantly lower necessity for skin grafts (p < 0.001), and we found a significantly lower infection rate (p < 0.001) than in Porcine Xenografts. Nonetheless, no significant differences in the healing time (p = 0.67) and the number of dressing changes until complete wound healing (p = 0.139) could be found. Both products reduced pain to various degrees with the impression of a better performance of Suprathel® on a qualitative level. Porcine xenograft was not recommended for donor sites or coverage of sheet-transplanted keratinocytes, while Suprathel® was used successfully in both indications. Conclusion: The investigated parameters indicate that Suprathel® to be an effective replacement for porcine xenografts with even lower subsequent treatment rates. Suprathel® appears to be usable in an extended range of indications compared to porcine xenograft. Data heterogeneity limited conclusions from the results.
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Affiliation(s)
| | - Sigrid E. Blome-Eberwein
- Lehigh Valley Health Network 1200 S. Cedar Crest Blvd. Kasych 3000, Allentown, PA 18103, USA; (S.E.B.-E.); (S.E.W.)
| | - Ludwik K. Branski
- Department of Surgery—Burn Surgery, The University of Texas Medical Branch and Shriners Hospitals for Children, 301 University BLVD, Galveston, TX 77555, USA;
| | - Joshua S. Carson
- Department of Surgery, UF Health Shands Burn Center, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610, USA;
| | - Roselle E. Crombie
- Connecticut Burn Center, Yale New Haven Heal System, 267 Grant St, Bridgeport, CT 06610, USA;
| | - William L. Hickerson
- Memphis Medical Center Burn Center, 890 Madison Avenue, Suite TG032, Memphis, TN 38103, USA;
| | - Lars Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University, 8053 Graz, Austria; (L.P.K.); (S.P.N.); (D.P.)
| | - Booker T. King
- Division of Burn Surgery, Department of Surgery, 101 Manning Drive CB #7206, Chapel Hill, NC 27599, USA;
| | - Sebastian P. Nischwitz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University, 8053 Graz, Austria; (L.P.K.); (S.P.N.); (D.P.)
| | - Daniel Popp
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University, 8053 Graz, Austria; (L.P.K.); (S.P.N.); (D.P.)
| | - Jeffrey W. Shupp
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC 20010, USA;
| | - Steven E. Wolf
- Lehigh Valley Health Network 1200 S. Cedar Crest Blvd. Kasych 3000, Allentown, PA 18103, USA; (S.E.B.-E.); (S.E.W.)
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Hodge S, Greaves N, Murray D. The Use of Bovine Pericardial Patches in Vascular Surgery: Where do we Draw the Line in Obtaining Informed Consent? Ann Vasc Surg 2021; 76:536-541. [PMID: 33905843 DOI: 10.1016/j.avsg.2021.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/07/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
For a patient undergoing a carotid endarterectomy, induction with propofol, administration of heparin at the time of vessel clamping, use of a bovine pericardial patch for angioplasty, covering the wound with a hydrocolloid dressing and post-operative aspirin administration exposes the patient to animal products at every stage, from the moment they walk through the door. A number of articles have advocated obtaining informed consent when using animal products in healthcare but where should the line be drawn? METHODS A narrative review of the literature, specifically focussing on secular and religious beliefs about the use of animal products in healthcare. Application of ethical principles and GMC guidance to formulatea discussion with regards to the use of bovine pericardium in vascular surgery. Advanced literature search carried out using Pubmed and Google Scholar databases comparing patch material used forcarotid endarterectomy. RESULTS Disclosing the use of animal derived constituents in surgery is warranted under Beauchamp and Childress' four principals and highlighted in GMC guidance. Obtaining consent for the use of animalderived constituents at the time of surgery is something that should become a fundamental component of the written consent process and alternatives should be sought where available and practicable. CONCLUSION This review highlights the evidence available and discusses our current standpoint from both a legal and ethical aspect.
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Affiliation(s)
- Stacie Hodge
- Department of Vascular and Endovascular Surgery, Manchester University NHS Trust, Manchester, United Kingdom.
| | - Nicholas Greaves
- Department of Vascular and Endovascular Surgery, Manchester University NHS Trust, Manchester, United Kingdom
| | - David Murray
- Department of Vascular and Endovascular Surgery, Manchester University NHS Trust, Manchester, United Kingdom
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Bostan LE, Clarkin CE, Mousa M, Worsley PR, Bader DL, Dawson JI, Evans ND. Synthetic Nanoclay Gels Do Not Cause Skin Irritation in Healthy Human Volunteers. ACS Biomater Sci Eng 2021; 7:2716-2722. [PMID: 33825442 DOI: 10.1021/acsbiomaterials.0c01615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Synthetic clays are promising biomaterials for delivery of therapeutic molecules in regenerative medicine. However, before their use can be translated into clinical applications, their safety must be assessed in human volunteers. The aim of this study was to test the hypothesis that a synthetic nanoclay (LAPONITE) does not cause irritation to the human skin. To achieve this, a nanoclay gel at two different concentrations (1.5 and 3% w/v) was applied on the forearm of healthy volunteers for 24 h. 1% sodium lauryl sulfate (SLS) and 3% (w/v) polyacrylic acid were used as the positive and negative controls, respectively. The compromise in the skin barrier function was measured by trans-epidermal water loss (TEWL), erythema by spectroscopic measurements, and skin inflammatory biomarkers (IL-1α and IL-1RA) by the enzyme-linked immunosorbent assay. We found that the nanoclay caused no prolonged increase in TEWL, erythema, or induction of inflammatory cytokines. This was in contrast to 1% SLS, a known irritant, which induced significant increases in both skin erythema and TEWL. We conclude that the nanoclay is not an irritant and is thus suitable for therapeutic interventions at the skin surface.
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Affiliation(s)
- Luciana E Bostan
- Centre for Human Development, Stem Cells and Regeneration, Institute for Developmental Sciences, Southampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, Hampshire, U.K
| | - Claire E Clarkin
- School of Biological Sciences, University of Southampton, Highfield Campus, University Road, Southampton SO17 1BJ, Hampshire, U.K
| | - Mohamed Mousa
- Centre for Human Development, Stem Cells and Regeneration, Institute for Developmental Sciences, Southampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, Hampshire, U.K
| | - Peter R Worsley
- Faculty of Health Sciences, University of Southampton, Highfield Campus, University Road, Southampton SO17 1BJ, U.K
| | - Daniel L Bader
- Faculty of Health Sciences, University of Southampton, Highfield Campus, University Road, Southampton SO17 1BJ, U.K
| | - Jonathan I Dawson
- Centre for Human Development, Stem Cells and Regeneration, Institute for Developmental Sciences, Southampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, Hampshire, U.K
| | - Nicholas D Evans
- Centre for Human Development, Stem Cells and Regeneration, Institute for Developmental Sciences, Southampton General Hospital, University of Southampton, Tremona Road, Southampton SO16 6YD, Hampshire, U.K
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Babos MB, Perry JD, Reed SA, Bugariu S, Hill-Norby S, Allen MJ, Corwell TK, Funck JE, Kabir KF, Sullivan KA, Watson AL, Wethington KK. Animal-derived medications: cultural considerations and available alternatives. J Osteopath Med 2021; 121:361-370. [PMID: 33694349 DOI: 10.1515/jom-2020-0052] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 10/20/2020] [Indexed: 11/15/2022]
Abstract
CONTEXT Cultural competency is a cornerstone of patient-centered health care. Religious doctrines may define appropriate consumption or use of certain animals and forbid use of others. Many medications contain ingredients that are animal-derived; these medications may be unacceptable to individual patients within the context of their religious beliefs and lifestyle choices. Knowledge of animal-derived medications as a component of cultural competency can facilitate a dialogue that shifts focus from the group to the individual, away from cultural competency toward cultural humility, and away from a paternalistic provider/patient dynamic toward one of partnership. OBJECTIVES To explore how animal-derived drug components may impact medication selection and acceptability from the perspective of patients, physicians, and religious leaders as evidenced by studies that explore the question via survey or questionnaire. A secondary objective is to use the context of animal-derived drug products as a component of cultural competency to build a framework supporting the development of cultural humility. METHODS A systematic search was performed in the PubMed, CINAHL, Cochrane, and ProQuest databases using combinations of the following terms: "medication selection," "medication," "adherence," "pharmaceutical preparations," "religion and medicine," "religion," "animal," "dietary," "porcine," and "bovine." Studies that reported using surveys or questionnaires to examine patient, physician, or religious leader perspective on animal-derived medications published in English between 1990 and 2020 were included. Review articles, opinion pieces, case reports, surveys of persons other than patients, religious leaders, or physicians, and studies published in languages other than English were excluded. Three authors independently reviewed articles to extract information pertaining to perspectives on animal-based medication ingredients. RESULTS Eight studies meeting the described criteria were found that queried beliefs or knowledge of patients, religious leaders, or physicians regarding medications and medical products of biologic origin. Those studies are described in full in this review. CONCLUSIONS Knowledge of animal-derived ingredients may help open conversations with patients around spiritual history and cultural competency, particularly for those patients belonging to religious sects with doctrines that define appropriate use of human- or animal-derived products. Further formal study is needed to explore more fully the extent to which religious beliefs may impact selection of animal- or human-derived medications. Guidelines developed from this knowledge may aid in identifying individual patients with whom the discussion may be particularly relevant. More studies are needed to quantify and qualify beliefs regarding animal-derived medication constituents.
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Affiliation(s)
- Mary Beth Babos
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Joseph D Perry
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Sara A Reed
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Sandra Bugariu
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Skyler Hill-Norby
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Mary Jewell Allen
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Tara K Corwell
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Jade E Funck
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Kaiser F Kabir
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Katherine A Sullivan
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Amber L Watson
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - K Kelli Wethington
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
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Iyun A, Ademola S, Olawoye O, Michael A, Aderibigbe R, Iyun O, Oluwatosin O. Glycerolised skin allografts for extensive burns in low- and middle-income countries. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2021; 11:35-41. [PMID: 36132972 PMCID: PMC9484497 DOI: 10.4103/jwas.jwas_55_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/07/2022] [Indexed: 11/23/2022]
Abstract
Introduction: There has been a significant improvement in the outcome of treatment of large surface area burns in developed countries. A major contributory factor is an early excision and skin grafting of burn wounds. The initial coverage of large surface area deep burn wounds requires the use of temporary skin substitutes such as allografts due to limited skin autografts. Cadaveric skin allografts are the commonest source of skin allografts in use; however, there may be religious, cultural, cost, or other factors mitigating its availability and routine use in low- and middle-income countries (LMICs). Human skin allografts may be used fresh or stored in tissue banks to ensure its ready availability. The purpose of this review is to promote glycerolised skin allografts as a means of skin preservation in low-resource countries above other modalities cryopreservation due to its cost advantages and relative ease of operation. Materials and Methods: A literature search for articles related to human skin allograft use in burn care, skin banks, and glycerolised skin allografts in LMICs was done using PubMed, EMBASE, and Web of Science databases. The key words used were ‘allograft’ and ‘burn’ with a filter in the search for human studies. The relevant references in the articles obtained were also searched for and included in the review Results: Sixty-three journal articles were reviewed for contents in line with the objectives of this study. Conclusion: Glycerolised skin graft is a viable option for coverage of extensive burns in LMICs.
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Romanos GE, Romanos EB, Alqahtani F, Alqahtani M, Javed F. "Religious Belief": An Undervalued Ethical Inclusion Criterion for Clinical Trials on Bone Grafting Procedures. JOURNAL OF RELIGION AND HEALTH 2020; 59:2928-2934. [PMID: 31154591 DOI: 10.1007/s10943-019-00851-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The aim of the present review was to assess randomized controlled trials (RCTs) on bone grafting procedures that included religious belief as an eligibility criterion. Indexed databases were searched up to and including February 2019 using different search strategies. In strategy 1, the following terms were used: (a) belief; (b) bone graft; (c) faith; (d) inclusion; (e) exclusion; (f) eligibility; (g) criteria; (h) randomized clinical trial; (i) religion; and (j) xenograft. In strategy 2, the following terms were used in addition to those used in strategy 1: Xenografts AND oral surgery OR xenografts AND maxillofacial OR xenografts AND dental implants. These searches were filtered using the terms "Randomized clinical trial" and "human studies". The initial search yielded 3932 studies. Filtration of results using the terms "Randomized clinical trial" and "human studies" showed 0 studies. Evaluation of patients' religious beliefs seems to be undervalued in RCTs related to the placement of xenografts. This is an essential and ethical criterion that should be taken into consideration prior to inclusion of participants and signing the informed consent form for RCTs related to the placement of bone grafts.
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Affiliation(s)
- Georgios E Romanos
- Department of Periodontology, Stony Brook University, Stony Brook, NY, USA
- Laboratory for Periodontal-, Implant-, Phototherapy (LA-PIP), School of Dental Medicine, Stony Brook University, Stony Brook, NY, 11794, USA
| | | | - Fawaz Alqahtani
- Department of Prosthodontics, College of Dentistry, Prince Sattam Bin Abdul-Aziz University, Al-Kharj, 11942, Saudi Arabia
| | - Mana Alqahtani
- Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
| | - Fawad Javed
- Department of Periodontology, Stony Brook University, Stony Brook, NY, USA.
- Laboratory for Periodontal-, Implant-, Phototherapy (LA-PIP), School of Dental Medicine, Stony Brook University, Stony Brook, NY, 11794, USA.
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Topical Hemostatic Agents at Time of Obstetric and Gynecologic Surgery: ACOG Committee Opinion, Number 812. Obstet Gynecol 2020; 136:e81-e89. [PMID: 32976379 DOI: 10.1097/aog.0000000000004104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are three broad categories of hemostatic agents: 1) caustic, 2) physical, and 3) biologic. Because of the paucity of data on the use of topical hemostatic agents in gynecologic and obstetric surgery, indications for use are extrapolated from data on the use of these agents in other types of surgeries and are based on expert opinion. Topical hemostatic agents can be a useful adjunct to assist in the management of intraoperative bleeding in select circumstances. Topical hemostatic agents most commonly are used in situations where the use of electrocautery or sutures for hemostatic control of surgical bleeding is not ideal or safe, including bleeding in areas with nearby vulnerable structures or in the presence of diffuse bleeding from peritoneal surfaces or cut surfaces of solid organs. When managing intraoperative bleeding, there is no substitute for meticulous surgical technique. When possible, the surgeon should attempt to control intraoperative bleeding with sutures, clips, or electrosurgery before the use of hemostatic agents. It is essential for surgeons to understand the appropriate use, contraindications, and cost of these agents in order to make the most informed decision for patient care.
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Rosenberg LB, Goodlev ER, Izen RSE, Gelfand SL, Goodlev CL, Lanckton RB, Skarf LM, Wershof Schwartz A, Jones CA, Tulsky JA. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Jewish Patients. J Palliat Med 2020; 23:1658-1661. [PMID: 33085936 DOI: 10.1089/jpm.2020.0601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Judaism, one of the world's oldest religions, claims an estimated 14.3 million members worldwide. There is great diversity in terms of identity, practice, and belief among people who identify as Jewish. As of 2017, 40% of the global Jewish community resided in the United States, making it essential for palliative care clinicians to understand religious and cultural issues related to their serious illness care. In this article, we will discuss 10 important concepts relevant to the inpatient care, advance care planning, and bereavement needs of Jewish patients and families.
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Affiliation(s)
- Leah B Rosenberg
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eric R Goodlev
- Division of Palliative Care, Department of Medicine, Einstein Medical Center Montgomery, East Norriton, Pennsylvania, USA
| | - Rabbi Shulamit E Izen
- Spiritual Care Department, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Samantha L Gelfand
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Lara M Skarf
- Division of Geriatrics and Palliative Care, Department of Medicine, Education and Clinical Centers, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | - Andrea Wershof Schwartz
- New England Geriatric Research, Education and Clinical Centers, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.,Department of Medicine/Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
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Koshy RM, Kane EG, Grocock C. A review of the use of biological mesh products in modern UK surgical practice: a religious and cultural perspective. Ann R Coll Surg Engl 2020; 102:566-570. [PMID: 32538113 PMCID: PMC7538734 DOI: 10.1308/rcsann.2020.0114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The UK is an increasingly multicultural society. This change coincides with an increasing use of animal products in medicine and surgery and a change in the UK law of consent. The refusal of Jehovah's Witnesses to accept blood products is well known, but the use of animal products in surgery is a neglected topic. As society becomes more diverse and medicine becomes ever more advanced, there is increasing potential for a mismatch between what is medically possible and what is acceptable from a religious perspective. METHODS Surgical products were identified by searching the literature and contacting manufacturing companies. Literature was identified by using PubMed and OVID (MEDLINE). Religious views were established by contacting national bodies for each group. FINDINGS The views of common UK religious groups and the constituent parts of biological meshes are summarised in tables intended to be used as a reference during clinical practice. On an elective basis, the Islamic, Hindu. Sikh and Jain leaders contacted had strong views on avoiding animal derived products. The Christian and Jewish leaders contacted did not. All religious leaders contacted accepted the use of mesh derived from human tissue. All products, including those of porcine and bovine origin, were acceptable to all leaders contacted if the procedure was performed to save life. The highlighting of this issue should prompt earlier consideration and discussion in the surgical planning and the consenting process with all final decisions taken by both the surgeon and the individual patient.
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Affiliation(s)
- RM Koshy
- University Hospital Coventry and Warwickshire, Coventry, UK
| | - EG Kane
- University of Liverpool, Liverpool, UK
| | - C Grocock
- Royal Liverpool University Hospital, Liverpool, UK
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Abstract
There have been significant advances in the care of burns over the past decade. As a result of the improved survival of burn patients, attention has shifted to the optimized management of their wounds. Traditionally, autografts have been described as the gold standard treatment in cases of deep second- and third-degree burn wounds; however, they are limited especially in large surface area burns. As such, advancements have been made in the development of biologic dressings, which attempt to mimic the function of the lost epidermis and/or dermis. The ideal biologic dressing is nontoxic, lacks antigenicity, is immunologically compatible, and is sterile. Additionally, easy storage conditions, long shelf lives, and reasonable costs are key determinants of whether biologic dressings may truly be widely used in the clinical setting. Biologic dressings serve an important role as skin substitutes in the setting of acute burn injury. This review aims to summarize the multitude of available biologic dressings and their applications. METHODS: The PubMed and Google Scholar databases were searched for the following terms either alone or in combination: "burn injury," "biologic membrane," "skin substitutes," "biosynthetic dressings," and "acellular membrane."
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Ooi KS, Haszman S, Wong YN, Soidin E, Hesham N, Mior MAA, Tabata Y, Ahmad I, Fauzi MB, Mohd Yunus MH. Physicochemical Characterization of Bilayer Hybrid Nanocellulose-Collagen as a Potential Wound Dressing. MATERIALS 2020; 13:ma13194352. [PMID: 33007893 PMCID: PMC7579490 DOI: 10.3390/ma13194352] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 12/11/2022]
Abstract
The eminent aim for advance wound management is to provide a great impact on the quality of life. Therefore, an excellent strategy for an ideal wound dressing is being developed that eliminates certain drawbacks while promoting tissue regeneration for the prevention of bacterial invasion. The aim of this study is to develop a bilayer hybrid biomatrix of natural origin for wound dressing. The bilayer hybrid bioscaffold was fabricated by the combination of ovine tendon collagen type I and palm tree-based nanocellulose. The fabricated biomatrix was then post-cross-linked with 0.1% (w/v) genipin (GNP). The physical characteristics were evaluated based on the microstructure, pore size, porosity, and water uptake capacity followed by degradation behaviour and mechanical strength. Chemical analysis was performed using energy-dispersive X-ray spectroscopy (EDX), Fourier transform infrared spectrophotometry (FTIR), and X-ray diffraction (XRD). The results demonstrated a uniform interconnected porous structure with optimal pore size ranging between 90 and 140 μm, acceptable porosity (>70%), and highwater uptake capacity (>1500%). The biodegradation rate of the fabricated biomatrix was extended to 22 days. Further analysis with EDX identified the main elements of the bioscaffold, which contains carbon (C) 50.28%, nitrogen (N) 18.78%, and oxygen (O) 30.94% based on the atomic percentage. FTIR reported the functional groups of collagen type I (amide A: 3302 cm-1, amide B: 2926 cm-1, amide I: 1631 cm-1, amide II: 1547 cm-1, and amide III: 1237 cm-1) and nanocellulose (pyranose ring), thus confirming the presence of collagen and nanocellulose in the bilayer hybrid scaffold. The XRD demonstrated a smooth wavy wavelength that is consistent with the amorphous material and less crystallinity. The combination of nanocellulose with collagen demonstrated a positive effect with an increase of Young's modulus. In conclusion, the fabricated bilayer hybrid bioscaffold demonstrated optimum physicochemical and mechanical properties that are suitable for skin wound dressing.
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Affiliation(s)
- Kai Shen Ooi
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (K.S.O.); (S.H.); (Y.N.W.); (E.S.); (N.H.); (M.A.A.M.)
| | - Shafieq Haszman
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (K.S.O.); (S.H.); (Y.N.W.); (E.S.); (N.H.); (M.A.A.M.)
| | - Yon Nie Wong
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (K.S.O.); (S.H.); (Y.N.W.); (E.S.); (N.H.); (M.A.A.M.)
| | - Emillia Soidin
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (K.S.O.); (S.H.); (Y.N.W.); (E.S.); (N.H.); (M.A.A.M.)
| | - Nadhirah Hesham
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (K.S.O.); (S.H.); (Y.N.W.); (E.S.); (N.H.); (M.A.A.M.)
| | - Muhammad Amirul Arif Mior
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (K.S.O.); (S.H.); (Y.N.W.); (E.S.); (N.H.); (M.A.A.M.)
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia;
| | - Yasuhiko Tabata
- Department of Biomaterials, Institute for Frontier Medical Sciences, Kyoto University, 53 Kawara-cho Shogoin, Sakyo-ku Kyoto 606-8507, Japan;
| | - Ishak Ahmad
- School of Chemical Sciences and Food Technology, Faculty of Science & Technology, Universiti Kebangsaan Malaysia, Selangor 43600, Malaysia;
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia;
| | - Mohd Heikal Mohd Yunus
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (K.S.O.); (S.H.); (Y.N.W.); (E.S.); (N.H.); (M.A.A.M.)
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia;
- Correspondence: or ; Tel.: +60-3-91458624
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Bentivegna K, DeWane ME, Parikh SA, Makkar HS, Finch J. Animal product in suture material: A survey study of dermatology patient perspectives. J Am Acad Dermatol 2020; 83:907-908. [DOI: 10.1016/j.jaad.2019.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/05/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
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Jamie K, Sharples G. The Social and Material Life of Antimicrobial Clay: Exploring Antimicrobial Resistance, Medicines' Materiality, and Medicines Optimization. FRONTIERS IN SOCIOLOGY 2020; 5:26. [PMID: 33869434 PMCID: PMC8022547 DOI: 10.3389/fsoc.2020.00026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/25/2020] [Indexed: 06/12/2023]
Abstract
While sociologists have made significant theoretical contributions to the antimicrobial resistance (AMR) debate, little attention has been given to the antimicrobial products themselves. Here we advocate a significant new direction which centers on the social and material life of antimicrobials, specifically on what they are made from and how this affects their use. This focus is timely because, in the context of declining efficacy of biomedical antibiotics, diverse materials are increasingly taking center stage in research and drug discovery as potential agents for new antimicrobial treatments. Of particular significance are natural antimicrobials, such as plants, honey and clay, whose antimicrobial potential is well-documented and which are increasingly moving into mainstream antimicrobial research. Alongside this biomedical focus, we suggest that the social and material lives of these antimicrobial materials require attention to (i) highlight the ways they have been, and continue to be, used in diverse cultures globally, (ii) explore ways we might theorize these materials within wider AMR debates, and (iii) examine the impact of antimicrobials' materiality on their use by patients. This article takes the example of clay, whose antimicrobial properties are well-established and which has been used to treat wounds and gastrointestinal problems for millennia. We first locate clay as an exemplar of a wider shift toward natural products drug discovery in pharmaceutical science and antimicrobial research. We then offer a number of theoretical "ways in" for sociologists to begin making sense of clay as it comes under the western biomedical gaze. We map these conceptual lenses on to clay's physical and symbolic mobility from its use in the global south into western biomedical research and commercialization. We particularly concentrate on post-colonial theory as a means to understand clay's movement from global south to north; laboratory studies to examine its symbolic transformation to a black-boxed antimicrobial artifact; and valuation practices as a lens to capture its movement from the margins to the mainstream. We finish by reflecting on the importance of materiality in addressing optimal use of medicines and by advocating an interdisciplinary approach to AMR which positions sociology as a key contributor to AMR solutions.
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Affiliation(s)
- Kimberly Jamie
- Department of Sociology, Durham University, Durham, United Kingdom
| | - Gary Sharples
- Department of Biosciences, Durham University, Durham, United Kingdom
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Merquiol L, Romano G, Ianora A, D'Ambra I. Biotechnological Applications of Scyphomedusae. Mar Drugs 2019; 17:E604. [PMID: 31653064 PMCID: PMC6891278 DOI: 10.3390/md17110604] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 12/31/2022] Open
Abstract
As people across the world live longer, chronic illness and diminished well-being are becoming major global public health challenges. Marine biotechnology may help overcome some of these challenges by developing new products and know-how derived from marine organisms. While some products from marine organisms such as microalgae, sponges, and fish have already found biotechnological applications, jellyfish have received little attention as a potential source of bioactive compounds. Nevertheless, recent studies have highlighted that scyphomedusae (Cnidaria, Scyphozoa) synthesise at least three main categories of compounds that may find biotechnological applications: collagen, fatty acids and components of crude venom. We review what is known about these compounds in scyphomedusae and their current biotechnological applications, which falls mainly into four categories of products: nutraceuticals, cosmeceuticals, biomedicals, and biomaterials. By defining the state of the art of biotechnological applications in scyphomedusae, we intend to promote the use of these bioactive compounds to increase the health and well-being of future societies.
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Affiliation(s)
- Louise Merquiol
- Integrative Marine Ecology Department, Stazione Zoologica Anton Dohrn, Villa Comunale, 80121 Napoli, Italy.
| | - Giovanna Romano
- Marine Biotechnology Department, Stazione Zoologica Anton Dohrn, Villa Comunale, 80121 Napoli, Italy.
| | - Adrianna Ianora
- Marine Biotechnology Department, Stazione Zoologica Anton Dohrn, Villa Comunale, 80121 Napoli, Italy.
| | - Isabella D'Ambra
- Integrative Marine Ecology Department, Stazione Zoologica Anton Dohrn, Villa Comunale, 80121 Napoli, Italy.
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Syiroj ATR, Pardosi JF, Heywood AE. Exploring parents' reasons for incomplete childhood immunisation in Indonesia. Vaccine 2019; 37:6486-6493. [PMID: 31522808 DOI: 10.1016/j.vaccine.2019.08.081] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Immunisation is one of the most successful interventions for controlling infectious diseases but relies on continuous high coverage. Parental vaccine refusal and logistical barriers to access are threats to the success of immunisation programs, with resultant population immunity gaps leading to outbreaks of vaccine-preventable diseases. In Indonesia, coverage of childhood vaccines is suboptimal, with poor coverage of diphtheria-tetanus-pertussis vaccine leading to a large diphtheria outbreak in 2017. METHODS To explore the underlying parents' reasons for incomplete childhood immunisation in Indonesia, semi-structured interviews were conducted in Tangerang Selatan, Banten Province, Indonesia. Sixteen purposively selected primary carers of partially and unimmunised children were interviewed. Transcripts were coded and analysed using inductive thematic analysis. RESULTS Parental reasons were categorised into three interrelated themes of belief barriers, safety concerns, and issues of trust and misinformation. Stark differences were evident in reasons provided by carers of unimmunised children compared to partially immunised children. For parents of unimmunised children, Islamic beliefs, belief in the strength of natural immunity, and the use of alternative medicines strongly influenced behaviours. Safety concerns, issues of trust including distrust in the government, misinformation, and trust in information obtained through social networks were also prominent. In contrast, concerns about mild side-effects and logistical barriers outweighed beliefs among carers of partially immunised children. CONCLUSIONS Our findings highlight the complexities in decision making for parents who decide not to vaccinate their children. In the Indonesian context, public health education and engagement of religious leaders to bridge the gap between religious beliefs and vaccine acceptance are needed to address vaccine refusal. Future research on the influence of social networks on vaccine hesitancy in the Indonesian context is also warranted. For parents of partially vaccinated children, interventions should focus on barriers of access to community health staff to encourage timely schedule completion.
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Affiliation(s)
- Agung Taufiqur Rokhman Syiroj
- National Population and Family Planning Board, East Java Province, Indonesia; School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | - Jerico Franciscus Pardosi
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia; School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia; National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Anita E Heywood
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Sum R, Lau KK. Use of Gelfoam in radiological procedures may have ethical and medicolegal implications. J Med Imaging Radiat Oncol 2019; 63:486. [DOI: 10.1111/1754-9485.12904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Reuben Sum
- Department of Diagnostic Imaging Monash Medical CentreMelbourne Victoria Australia
| | - Kenneth K. Lau
- Department of Diagnostic Imaging Monash Medical CentreMelbourne Victoria Australia
- Monash University Melbourne Victoria Australia
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Superiority of silver-foam over porcine xenograft dressings for treatment of scalds in children: A prospective randomised controlled trial. Burns 2019; 45:1401-1409. [PMID: 31230798 DOI: 10.1016/j.burns.2019.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/13/2019] [Accepted: 04/04/2019] [Indexed: 02/08/2023]
Abstract
AIM Our aim was to compare two different regimens for the treatment of children with partial-thickness scalds. These were treated with either a porcine xenograft (EZderm®, Mölnlycke Health Care, Gothenburg, Sweden) or a silver-foam dressing (Mepilex® Ag, Mölnlycke Health Care, Gothenburg, Sweden). METHODS We organised a prospective randomised clinical trial that included 58 children admitted between May 2015 and May 2018 with partial-thickness scalds to The Burn Centre in Linkoping, Sweden. The primary outcome was time to healing. Secondary outcomes were pain, need for operation, wound infection, duration of hospital stay, changes of dressings, and time taken. RESULTS The patients treated with silver-foam dressing had a significantly shorter healing time. The median time to 97% healing for this group was 9 (7-23) days compared to 15 (9-29) days in the porcine xenograft group (p = 0.004). The median time to complete healing for the silver-foam group was 15 (9-29) days and for the porcine xenograft group 20.5 (11-42) days (p = 0.010). Pain, wound infection, duration of hospital stay, and the proportion of operations were similar between the groups. Number of dressing changes and time for dressing changes were lower in the silver-foam dressing group (p = 0.03 for both variables). CONCLUSIONS We compared two different treatments for children with partial-thickness scalds, and the data indicate that wound healing was faster, fewer dressing changes were needed, and dressing times were shorter in the silver-foam group.
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Jolly K, Darr A, Aslanidou A, Bowyer D, Ahmed S. The intra‐operative use of biological products: A multi‐centre regional patient perspective of a potential consenting conundrum. Clin Otolaryngol 2019; 44:831-835. [DOI: 10.1111/coa.13367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/16/2019] [Accepted: 05/12/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Karan Jolly
- Department of Otolaryngology University Hospitals Birmingham NHS Trust Birmingham UK
| | - Adnan Darr
- Department of Otolaryngology Shrewsbury and Telford Hospital NHS Trust Shrewsbury UK
| | - Anastasia Aslanidou
- Department of Otolaryngology University Hospitals Birmingham NHS Trust Birmingham UK
| | - Duncan Bowyer
- Department of Otolaryngology Shrewsbury and Telford Hospital NHS Trust Shrewsbury UK
| | - Shahzada Ahmed
- Department of Otolaryngology University Hospitals Birmingham NHS Trust Birmingham UK
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Offner D, de Grado GF, Meisels I, Pijnenburg L, Fioretti F, Benkirane-Jessel N, Musset AM. Bone Grafts, Bone Substitutes and Regenerative Medicine Acceptance for the Management of Bone Defects Among French Population: Issues about Ethics, Religion or Fear? CELL MEDICINE 2019; 11:2155179019857661. [PMID: 32634194 PMCID: PMC6587382 DOI: 10.1177/2155179019857661] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/21/2019] [Indexed: 12/13/2022]
Abstract
Several techniques exist to manage bone defects in patients: bone grafts (autograft, allograft, xenograft), use of synthetic bone substitutes, or use of the products of bone regenerative medicine. Studies generally focus on their efficacy, but few focus on their acceptance. Our objectives were to assess their theoretical acceptance among the French general population, and to identify issues justifying refusals, by mean of an open e-questionnaire. The questionnaire was submitted to a general French population, and explained these techniques in an understandable way. Participants were asked to say whether they would accept or refuse these techniques, specifying why in case of refusal (fear of the technique, ethical reasons, religious reasons). In total, 562 persons participated. Autograft and use of the products of bone regenerative medicine were the most accepted techniques (93.4% and 94.1%, respectively). Xenograft was the least accepted technique (58.2%). Most refusals were due to fear such as failure, pain, infection (autograft 8%, allograft 14.9%, xenograft 25.3%, synthetic bone substitutes 14.6%, and products of bone regenerative medicine 6.8%). Ethical reasons were mostly mentioned for allograft (6.4%) and xenograft (18.3%). Religious reasons were scarcely mentioned, only for xenograft (1.2%). Thus, acceptance of techniques does not seem to be greatly linked to sociodemographic characteristics in France. However, other countries with their own cultural, religious, and population patterns may show different levels of acceptance. This study shows that bone regenerative medicine is a promising research direction, reaching biological and also humanist quality standards, expected to improve the health of patients. Information is still the cornerstone to defuse issues about fear.
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Affiliation(s)
- Damien Offner
- INSERM (French National Institute of Health and Medical Research), UMR1260, Regenerative Nanomedicine (RNM), FMTS
- Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg
- Hôpitaux Universitaires de Strasbourg, Strasbourg
- Both the authors contributed equally to this article
| | - Gabriel Fernandez de Grado
- INSERM (French National Institute of Health and Medical Research), UMR1260, Regenerative Nanomedicine (RNM), FMTS
- Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg
- Hôpitaux Universitaires de Strasbourg, Strasbourg
- Both the authors contributed equally to this article
| | - Inès Meisels
- Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg
- Hôpitaux Universitaires de Strasbourg, Strasbourg
| | - Luc Pijnenburg
- INSERM (French National Institute of Health and Medical Research), UMR1260, Regenerative Nanomedicine (RNM), FMTS
- Hôpitaux Universitaires de Strasbourg, Strasbourg
- Faculté de Médecine, Université de Strasbourg, Strasbourg
| | - Florence Fioretti
- INSERM (French National Institute of Health and Medical Research), UMR1260, Regenerative Nanomedicine (RNM), FMTS
- Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg
- Hôpitaux Universitaires de Strasbourg, Strasbourg
| | - Nadia Benkirane-Jessel
- INSERM (French National Institute of Health and Medical Research), UMR1260, Regenerative Nanomedicine (RNM), FMTS
- Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg
- Faculté de Médecine, Université de Strasbourg, Strasbourg
| | - Anne-Marie Musset
- INSERM (French National Institute of Health and Medical Research), UMR1260, Regenerative Nanomedicine (RNM), FMTS
- Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg
- Hôpitaux Universitaires de Strasbourg, Strasbourg
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Philbrick AM, Wicks CM, Harris IM, Shaft GM, Van Vooren JS. Make Refugee Health Care Great [Again]. Am J Public Health 2019; 107:656-658. [PMID: 28398805 DOI: 10.2105/ajph.2017.303740] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ann M Philbrick
- Ann M. Philbrick is with University of Minnesota-Twin Cities College of Pharmacy, Department of Pharmaceutical Care & Health Systems, Minneapolis. Cherilyn M. Wicks, Ila M. Harris, and James S. Van Vooren are with University of Minnesota-Twin Cities Medical School, Department of Family Medicine and Community Health. Grant M. Shaft is with Walgreens, Roseville, MN
| | - Cherilyn M Wicks
- Ann M. Philbrick is with University of Minnesota-Twin Cities College of Pharmacy, Department of Pharmaceutical Care & Health Systems, Minneapolis. Cherilyn M. Wicks, Ila M. Harris, and James S. Van Vooren are with University of Minnesota-Twin Cities Medical School, Department of Family Medicine and Community Health. Grant M. Shaft is with Walgreens, Roseville, MN
| | - Ila M Harris
- Ann M. Philbrick is with University of Minnesota-Twin Cities College of Pharmacy, Department of Pharmaceutical Care & Health Systems, Minneapolis. Cherilyn M. Wicks, Ila M. Harris, and James S. Van Vooren are with University of Minnesota-Twin Cities Medical School, Department of Family Medicine and Community Health. Grant M. Shaft is with Walgreens, Roseville, MN
| | - Grant M Shaft
- Ann M. Philbrick is with University of Minnesota-Twin Cities College of Pharmacy, Department of Pharmaceutical Care & Health Systems, Minneapolis. Cherilyn M. Wicks, Ila M. Harris, and James S. Van Vooren are with University of Minnesota-Twin Cities Medical School, Department of Family Medicine and Community Health. Grant M. Shaft is with Walgreens, Roseville, MN
| | - James S Van Vooren
- Ann M. Philbrick is with University of Minnesota-Twin Cities College of Pharmacy, Department of Pharmaceutical Care & Health Systems, Minneapolis. Cherilyn M. Wicks, Ila M. Harris, and James S. Van Vooren are with University of Minnesota-Twin Cities Medical School, Department of Family Medicine and Community Health. Grant M. Shaft is with Walgreens, Roseville, MN
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Rodger D, Blackshaw BP. Using animal-derived constituents in anaesthesia and surgery: the case for disclosing to patients. BMC Med Ethics 2019; 20:14. [PMID: 30777063 PMCID: PMC6379939 DOI: 10.1186/s12910-019-0351-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Animal-derived constituents are frequently used in anaesthesia and surgery, and patients are seldom informed of this. This is problematic for a growing minority of patients who may have religious or secular concerns about their use in their care. It is not currently common practice to inform patients about the use of animal-derived constituents, yet what little empirical data does exist indicates that many patients want the opportunity to give their informed consent. DISCUSSION First we review the nature and scale of the problem by looking at the groups who may have concerns about the use of animal-derived constituents in their care. We then summarise some of the products used in anaesthesia and surgery that can contain such constituents, such as anaesthetic drugs, surgical implants and dressings. Finally, we explore the problem of animal-derived constituents and consent using Beauchamp and Childress' four principles approach, examining issues of autonomy, beneficence, nonmaleficence and justice. Disclosing the use of animal-derived constituents in anaesthesia and surgery is warranted under Beauchamp and Childress' four principles approach to the problem. Although there exist systemic and practical challenges to implementing this in practice, the ethical case for doing so is strong. The Montgomery ruling presents additional legal reason for disclosure because it entails that patients must be made aware of risks associated with their treatment that they attach significance to.
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Affiliation(s)
- Daniel Rodger
- Department of Allied Health Sciences, School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA England
| | - Bruce P. Blackshaw
- Department of Philosophy, School of Philosophy, Theology and Religion, University of Birmingham, Birmingham, England
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Gelatin: a chewy debate. Br Dent J 2019; 226:240-241. [DOI: 10.1038/s41415-019-0037-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Karlsson M, Olofsson P, Steinvall I, Sjöberg F, Thorfinn J, Elmasry M. Three Years' Experience of a Novel Biosynthetic Cellulose Dressing in Burns. Adv Wound Care (New Rochelle) 2019; 8:71-76. [PMID: 30809423 PMCID: PMC6389762 DOI: 10.1089/wound.2018.0790] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/06/2018] [Indexed: 11/19/2022] Open
Abstract
Objective: The use of porcine xenograft (PX) is widely spread in burn care. However, it may cause immunologic responses and other ethical and cultural considerations in different cultures. Therefore, there is a need for alternatives. The aim of this work is to test a novel biosynthetic cellulose dressing (Epiprotect®) on burn patients. Approach: Charts from 38 patients with superficial burns (SBs) (n = 18) or excised burns (n = 20) that got biosynthetic cellulose dressing instead of PX at a national burn center during 3 years were reviewed. Time to healing, length of stay, and wound infection were extracted from the medical records. Results: SBs hospitalization time was 11 days comparable to PXs reported by others. In the excised group, median duration of hospital stay was 35 days. Time to healing was 28 days. Seven wound infections were confirmed in the superficial group (39%) and 11 infections in the excised group (61%). Patients with superficial wounds reported pain relief on application. Innovation: A dressing (17 × 21 cm) consisting of biosynthetic cellulose replacing PX. Conclusion: Outcome of treatment of SBs or temporary coverage of excised deep burns with biosynthetic cellulose is comparable to treatment with PX. However, biosynthetic cellulose has benefits such as providing pain relief on application and ethical or cultural issues with the material is nonexistent.
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Affiliation(s)
- Matilda Karlsson
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden
| | - Pia Olofsson
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ingrid Steinvall
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Folke Sjöberg
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Anaesthesiology and Intensive Care, Linköping University, Linköping, Sweden
| | - Johan Thorfinn
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Moustafa Elmasry
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Surgery Department, Suez Canal University, Ismailia, Egypt
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