Once Upon a Microscopic Slide: The Story of Histology

For centuries, histology has maintained its remarkable place in the medical curriculum. However, its teaching has been influenced by the new technological advancement that has reshaped medicine teaching into a more modern student-friendly form. Since its inception in the 18th century, the discipline of histology has progressed hand in hand with the advancements in microscopy and microscopic technologies, including immunohistochemistry. In the traditional curriculum of USA medical schools, especially after the first Flexner’s report of 1910, histology was considered as very essential topic for a physician studying the “Art and Science” of medicine. In this era, the teaching relied more on the light microscope and to some extent on the electron microscope. However, the field nowadays, after the second Flexner’s report, which stressed the importance of integrating clinical topics in the curriculum, is shifting towards the use of more electronic resources for teaching. Such new resources rely on information technology and electronic imaging modalities which are considered to be more student-friendly, time efficient, consistent in conveying the images, promote self-learning and are less costly. In fact, in the last 25 years, most universities started relying on virtual microscopy with limited use of the light microscopy by the students. Such an approach facilitated curricular integration of histology into histopathology and provided the opportunity to promote self-learning and clinical relevance. In the era of competency-based curriculum, histology remains an essential and indispensable basic science in the integrated module

The Advancement of Postmortem Investigations in Sudden Cardiac Death

Sudden cardiac death (SCD) is a major public health issue accounting for 15–20% of all-cause deaths. Several pathologies have been associated with sudden cardiac arrest. Clinical autopsies have always contributed to invention of novel strategies for SCD prevention. One of the serious challenges that pathologists are facing is the significant decline of the overall autopsy rate. Many reasons have been associated with this change, most importantly, the evolution process in the postmortem investigation tools. However, cardiologists seem unsatisfied with the new non-invasive imaging techniques and still believe in the traditional autopsy as a gold standard in diagnosis of cardiovascular diseases. In this chapter, we focused on the importance of autopsy in the prevention of SCD by shedding a light on guidelines of minimum requirement for routine autopsy investigation of SCD (including macroscopic, histological, toxicological and molecular examination). We also gave insight into the new radiological techniques, their advantages and related diagnostic pitfalls as compared to that of conventional autopsy. Thus, providing a comprehensive understanding on the advancement of postmortem examination will help improve the minimum standards of routine autopsy practice, develop new guidelines for radiological examination and prevent the growing heterogeneity of the pathologies underlying SCD

Communicable Diseases Among Refugees with a Focus on the Middle East

During the past few years, millions of refugees from the Middle East and North Africa fled their countries to almost everywhere in the globe. Civil wars and acts of violence are the main reasons behind the exodus of populations seeking a better life and more secure living conditions. In fact, the current conflict in Syria and Iraq led to massive influx of refugees worldwide and in particular to neighboring countries of the Middle East. This refugee situation is unparalleled since the end of World War II. Besides the individual tragedies of refugees, a public health disaster is being witnessed in the countries of origin which, in many instances, affect the hosting countries as well. Many of these hosting countries witnessed a re-emergence of numerous communicable diseases as a result of the influx of refugees; they were unprepared, and their health sectors did not deliver the adequate response. In this chapter, we review major sexually transmitted diseases in refugees, with a focus on the Middle East. We also discuss the major actions taken in response to the ongoing displacement of refugees by the Government of Lebanon and suggest solutions and recommendations to the Lebanese public health system which is facing new urgent challenges

Inflammatory bowel disease, colorectal cancer and type 2 diabetes mellitus: The links.

The co-occurrence of the three disease entities, inflammatory bowel disease (IBD), colorectal cancer (CRC), type 2diabetes mellitus (T2DM) along with inflammation and dismicrobism has been frequently reported. Some authors have even suggested that dysbiosis could be the link through a molecular crosstalk of multiple inflammatory loops including TGFβ, NFKB, TNFα and ROS among others. This review focuses on the inflammatory process along with the role of microbiota in the pathophysiology of the three diseases. The etiology of IBD is multifactorial, and like CRC and T2DM, it is associated with a widespread and sustained GI inflammation and dismicrobism, whereby an array of pro-inflammatory mediators and other related biomolecules are up-regulated, both locally and systematically. Such a persistent or an inadequately resolved chronic inflammation may be a causative agent, in the presence other factors, leading to several pathologies such as IBD, CRC and T2DM. TGFβ plays a crucial role in pancreatic β cell malfunctioning as glucotoxicity stimulates its signaling cascade through smad 3, IL-6 and epithelial to mesenchymal transition. Such a cascade could lead to macrophages and other cells recruitment, inflammation, then IBD and CRC. NFkB is also another key regulator in the crosstalk among the pathways leading to the three disease entities. It plays a major role in linking inflammation to cancer development through its ability to up regulate several inflammatory and tumor promoting cytokines like: IL-6, IL-1 α and TNF α, as well as genes like BCL2 and BCLXL. It activates JAK/STAT signaling network via STAT3 transcription factors and promotes epithelial to mesenchymal transition. It also increases the risk for T2DM in obese people. In brief, NFKB is a matchmaker between inflammation, IBD, cancer and diabetes. In addition, TNFα plays a pivotal role in systemic inflammation. It is increased in the mucosa of IBD patients and has a central role in its pathogenesis. It also activates other signaling pathways like NFKB and MAPK leading to CRC. It is also overexpressed in the adipose tissues of obese patients thus linking it to T2DM, chronic inflammation and consequently CRC. On the other hand, increasing evidence suggests that dysbiosis plays a role in initiating, maintaining and determining the severity of IBD. Actually, among its functions, it modulates genotoxic metabolites which are able to induce CRC, a fact proven to be sustained by stool transfer from patients with CRC. Probiotics, however, may actively prevent CRC as well as IBD and results in a significant decrease in fasting glycemia in T2DM patients. In conclusion, IBD, CRC and T2DM are commonly occurring interrelated clinical problems. They share a common basis influenced by an inflammatory process, an imbalance in intestinal microbiota, and a crosstalk between various signaling pathways. Would probiotics interrupt the crosstalk or orient it in the physiological direction

HIV-Infected Children and Nutrition: The Friend and The Foe

The impact of nutrition on HIV-infected children has been evaluated in multiple studies. Our review of the current trends of nutrition-related studies revealed that the focus has moved from simply the disease consequences of HIV to ensuring that antiretroviral therapy-treated children are well nourished to ensure growth and development. This update aims to present the state of the art regarding nutrition of HIV-infected children and the real potential for nutrition to serve as a dynamic therapy in this group. Recent World Health Organization reports indicate that the HIV/AIDS disease is curbing in incidence worldwide despite the high 1.8 million children, less than 15 years, reported in 2017. In addition, the literature supports the complexity and bidirectional relation between nutrition and HIV. HIV infection has a substantial effect on the nutritional status, in particular, the gastrointestinal side effects, which, in turn, have a profound impact on HIV infection. Advances in the field have transformed the course of the disease into a chronic illness, where more attention was given to lifestyle and quality of life including nutrition. However, achievement of food security, nutrition accessibility, and appropriate handling of nutrition-related complications of HIV infection are remarkable challenges, particularly, in resource poor environments, where most HIV infections exist

The Use of Stem Cells in Burn Wound Healing: A Review

Burn wound healing involves a series of complex processes which are subject to intensive investigations to improve the outcomes, in particular, the healing time and the quality of the scar. Burn injuries, especially severe ones, are proving to have devastating effects on the affected patients. Stem cells have been recently applied in the field to promote superior healing of the wounds. Not only have stem cells been shown to promote better and faster healing of the burn wounds, but also they have decreased the inflammation levels with less scar progression and fibrosis. This review aims to highlight the beneficial therapeutic effect of stem cells in burn wound healing and to discuss the involved pathways and signaling molecules. The review covers various types of burn wound healing like skin and corneal burns, along with the alternative recent therapies being studied in the field of burn wound healing. The current reflection of the attitudes of people regarding the use of stem cells in burn wound healing is also stated

Perceptions of human cadaver dissection by medical students: a highly valued experience

Cadaver dissection remains a cornerstone in the study of anatomical sciences by medical students. However, this activity can cause emotions that may affect learning outcomes. This study, which involved medical students of various cultural backgrounds, assessed their responses to dissection. Medicine I year students (n = 100) at Oakland University William Beaumont School of Medicine were invited to complete a questionnaire after the first week of dissection, and again at the end of the course. The questionnaire asked for demographics, and assessed the students’ appraisal of their dissection experience, cultural influences, coping activities and learning outcomes. After the first week of dissection, most of the students found the experience challenging, stimulating, exciting and informative, rather than nauseating or unbearable. Still, some students found the experience anxiety-provoking, especially when they thought about human mortality. Cultural background influenced the students’ emotional development as they worked through the course. Most of the participants agreed that dissection promotes teamwork, familiarity with the human body, and integration of the theoretical knowledge with practical application. At the end of the course, dissection was significantly less anxiety-provoking, and, interestingly, the study found that culture and religious beliefs became more important to the students. Most students agreed that dissection is important, relevant, and necessary, and has the potential to improve learning outcomes that are essential to the development of physicians. The study suggests that an introductory course in social, behavioral and ethical considerations be presented at the beginning of the medical curriculum