In late 2019, reports arose of a new respiratory disease in China, identified as a novel coronavirus, severe acute respiratory syndrome coronavirus 2. The World Health Organisation named the disease caused by the virus ‘coronavirus disease 2019 (COVID-19)’. It was declared a pandemic in early 2020, after the disease rapidly spread across the world. COVID-19 has not only resulted in substantial morbidity and mortality but also significantly impacted healthcare service provision and training across all medical specialties with gastroenterology and Hepatology services being no exception. Internationally, most, if not all ‘non-urgent’ services have been placed on hold during surges of infections. As a result there have been delayed diagnoses, procedures, and surgeries which will undoubtedly result in increased morbidity and mortality. Outpatient services have been converted to remote consultations where possible in many countries. Trainees have been redeployed to help care for COVID-19 patients in other settings, resulting in disruption to their training - particularly endoscopy and outpatient clinics. This has led to significant anxiety amongst trainees, and risks prolongation of training. It is of the utmost importance to develop strategies that continue to support COVID-19-related service provision, whilst also supporting existing and future gastroenterology and Hepatology services and training. Changes to healthcare provision during the pandemic have generated new and improved frameworks of service and training delivery, which can be adopted in the post-COVID-19 world, leading to enhanced patient care.
Parenteral nutrition-associated cholestasis (PNAC) is a severe complication of parenteral nutrition. Standard feed preparations contain soybean and olive oil that are rich in ω-6 polyunsaturated fats, and which studies suggest can be hepatotoxic. Preparations containing fish oil, rich in ω-3 polyunsaturated fats, may be hepatoprotective and have been used in the critical care setting as immunotherapy. A case demonstrating dramatic improvement in liver function and overall clinical condition in an adult with PNAC and intestinal failure within 8 weeks of changing to a fish oil-based parenteral feed is reported. As far as is known, this is the first report of an adult patient whose parenteral nutrition-associated liver disease resolved after a parenteral nutrition lipid emulsion was changed to the fish oil-containing emulsion, SMOFlipid.
This paper explores different aspects of racism within the context of the novel Children of Blood and Bone (2018) by Tomi Adeyemi, utilizing Critical Race Theory or CRT as an analytical tool. The novel is written within the genre of Young Adult Fiction which tackles the problems of young adults. Although the events of the novel take place in a fantastical setting, they capture reality and depict the lives of black African Americans. Black African Americans in the novel are represented by the oppressed minority who are the diviners. Critical Race Theory recognizes that the legacy of slavery and the racial subordination of black Americans are not only socially inherent within the non-black society but they are still covert in the legal and caste system. The novel is analyzed according to the five tenets of Critical Race Theory which can be listed as follows: Race is a social construct, Racism is ordinary, Intersectionality, Interests convergence, and Counter-Storytelling. These five basic tenets will be examined thoroughly in the paper in relation to the events of the novel.
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