PI3K/AKT/mTOR Signaling Pathway in HPV-Driven Head and Neck Carcinogenesis: Therapeutic Implications

High-risk human papillomaviruses (HR-HPVs) are the causal agents of cervical, anogenital and a subset of head and neck carcinomas (HNCs). Indeed, oropharyngeal cancers are a type of HNC highly associated with HR-HPV infections and constitute a specific clinical entity. The oncogenic mechanism of HR-HPV involves E6/E7 oncoprotein overexpression for promoting cell immortalization and transformation, through the downregulation of p53 and pRB tumor suppressor proteins, among other cellular targets. Additionally, E6/E7 proteins are involved in promoting PI3K/AKT/mTOR signaling pathway alterations. In this review, we address the relationship between HR-HPV and PI3K/AKT/mTOR signaling pathway activation in HNC with an emphasis on its therapeutic importance.

Medical education and mental health during COVID-19: a survey across 9 countries

OBJECTIVES

To investigate students' experience with medical education alongside their mental and physical health since the onset of the COVID-19 pandemic across nine countries.

METHODS

A cross-sectional online survey was distributed by local collaborators to 2,280 medical students across 148 medical schools in Brazil, Chile, Colombia, Germany, Italy, Japan, Mexico, Spain, and Venezuela using non-probability convenience sampling from June 22 to July 24, 2020. Students answered questions regarding teaching, internet use, COVID-19, physical and mental well-being. A multivariate logistic regression examined factors associated with depressed mood, insomnia, and headache.

RESULTS

Academic teaching shifted to a virtual (67%, n=1,534) or hybrid environment (23%, n=531), whilst bedside teaching was suspended or cancelled (93%, n=2,120). Across all countries students were equally satisfied with the teaching modality, quantity, quality, and the evaluation system of in-person, hybrid, and online curricula. Negative changes in mental (40% (n=912) insomnia, 57% (n=1,300) emotional irritability, 47% (n=1,072) emotional instability, 41% (n=935) anhedonia, 40% (n=912) depressed mood) and physical (36% (n=821) headache, 57% (n=1,299) ocular tiredness, 49% (n=1,117) backache) health symptoms were frequently observed. Positive associations between the number of daily screen hours and depressed mood (adjusted odds ratio (AOR)=1.09, 95%CI: 1.05-1.12, p<.001), insomnia (AOR=1.08, 95%CI: 1.05-1.11, p<.001), and headache (AOR=1.11, 95%CI: 1.07-1.14, p<.001) were identified.

CONCLUSIONS

Students' experience with digital and hybrid medical curricula was diverse during the pandemic. Education modality, quantity, and quality were positively evaluated. However, students' mental and physical health worsened. Besides bedside teaching, faculties ought to digitalize and strengthen social communities and extend support services for students.

Lifestyle Changes Among Medical Students During COVID-19 Pandemic: A Multicenter Study Across Nine Countries

The global pandemic caused by coronavirus disease-2019 (COVID-19) disrupted both public and private life for many. Concerning medical students, practical teaching and classrooms were substituted with a virtual curriculum. However, how this new academic environment has affected students' health and lifestyles has yet to be studied. In this study, we surveyed 2,776 students from nine different countries about changes in their university curricula and potential alterations in their daily habits, physical health, and psychological status. We found negative changes across all countries studied, in multiple categories. We found that 99% of respondents indicated changes in their instruction delivery system, with 90% stating a transition to online education, and 93% stating a reduction or suspension of their practical activities. On average, students spent 8.7 hours a day in front of a screen, with significant differences among countries. Students reported worsened studying, sleeping, and eating habits with substantial differences in Latin American countries. Finally, the participants frequently expressed onset and increase in both mental and physical health symptoms: backache, asthenopia, irritability, and emotional instability. Altogether, these results suggest a potential risk in the health and academic performance of future doctors if these new academic modalities are maintained.