Research in Basic Sciences Is Essential for Creating New Ideas for Practice and Learning of Surgery

Although we do not have exact data due to unreported cases, the American Association of Poison Control Centers reports 2,560,308 human exposures in 2017, of which 79% were by ingestion. In 7.4% of the cases, the substance involved were household cleaning products followed by cosmetics and personal care products (6.8%), both only below analgesics (11.1%). In children under 6 years (999,529 cases), the main substances involved were cosmetics and personal care products (12.6%) followed by household cleaning products (11%) adding up to 23.6%, which means that 1 in 5 poison exposure cases is with substances that may contain caustics [1]. This scenario has a great implication in public health because the most vulnerable population is children. In the emergency department, 8 out of 10 patients affected are children mainly for accidental ingestion followed by adults between 30 and 40 years mostly for suicidal purposes. Although prevention is the most important point to consider; when the event happens, fast and effective attention to avoid complications is essential. From 70% to 90% of patients would not require immediate surgery (i.e. esophageal or gastric resection) as the lesion are below 3a grade according to Zargar classification [2]. The most common complication is stenosis that regularly develops during the first 2 months after ingestion and it should be treated by endoscopic dilatation [3].

Although systemic or local steroids have been used, as well as antibiotics, none has proven effective [4]. Thus, unfortunately there is no specific treatment that allows adequate recovery in these patients who will have a low quality of life and malnutrition associated with the mechanical dysphagia due to stenosis [3]. It is in this context that research is needed on new agents that eliminate or reduce the stenosis secondary to inflammation by the ingestion of caustics, especially in the esophagus; the most affected organ in these cases [2]. There are some approaches in animal models (i.e. fluorouracil, octreotide and cytokines). Carvacrol; being a substance with anti-inflammatory and antioxidant properties, it could be an option for the prevention of stenosis due to the ingestion of caustics [5].

The authors of the article in comment investigate the possible protective effect of carvacrol in esophageal burn due to caustic ingestion [6]. They used a model of esophageal burn in 24 Wistar rats divided into 3 groups: control (saline only), witness (esophageal burn only) and treatment (esophageal burn and application of Carvacrol). They observed, after 10 days, the histological changes, the measurement of vascular endothelial growth factor and caspases. They obtained a reduction of the fibrosis to the histological determination in addition to observing a decrease in the expression of caspase-3 and vascular endothelial growth factor in treatment group with respect to the witness group.

This basic research article with potentials to be transferred to clinical practice is well designed and carried out. There is some minor limitation: The lesions studied on this animal model are much more severe than what happen in humans and the stenosis development about 2 months after the injury; so we cannot evaluate if this approach really work on more real clinical scenarios. More translational research is needed to achieve an optimal clinical human outcome. Despite these deficiencies, the objective of detect decrease in inflammation process is done.

This basic sciences paper is an example of how to initiate a road to translational medicine. The main objective of research is inspiring new strategies to know, treat and therefore improve patient’s health. Surgeon should not only remain just as learner of the established guidelines and applying procedures already known. It is not the techniques or performing procedures repeatedly that will shape a physician. Clinical uncertainty must make us stand up from the comfort of the chair of replications so that each one of us could elaborate creative solutions for everyday problems through high mental rank thoughts.

Science (with its method) is the activity that has brought us as close as possible to the effective solution of everyday health problems. Knowing the recent findings of basic science allows elaborating and collaborating in translational medicine projects reducing the “translational gap” [7]. Although not all doctors will be basic, clinical or translational researchers, this does not exempt us from knowing how to do science. It is mandatory to know advances in our area of expertise and participating as far as possible, necessarily in our training and optionally in our professional practice; in large-scale translational projects [8]. Clinical and surgical doctors are fundamental in the final phase in the creation of new treatments and they are the main responsible of direct application of this advances on the patients as well as principal source of new ideas based on daily clinical practice [9]. Medicine is not a discipline of just memory and application of rules (no matter how complex or difficult they are); it is a way of thinking, putting ethical care of patient as our highest priority [10]. The most valuable part of medical thinking is developing or participating on the creation of new methods (scientific and creative) to solve health problems.

Declaration of Interest

The author reports no conflict of interest.