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Summary: What is known and objective: Hawaii will ban two major ingredients of sunscreens. This article reviews the reasons and future directions. Hawaii recently enacted legislation that will ban the use of two major ingredients of the majority of commonly used sunscreens. The reason for the ban is the ingredients' putative deleterious impact on marine ecosystems, particularly coral reefs. But sunscreens also save lives by decreasing the risk of UV‐induced skin cancers. We review both sides of the issue and potential implications for the healthcare system. Comment: Coral reefs consist of organisms in delicate equilibria that are susceptible to small changes in their surroundings. Recent natural and man‐made disruptions, direct or indirect, such as changes in ocean temperature and chemistry, ingress of invasive species, pathogens, pollution and deleterious fishing practices, have been blamed for the poor health, or even the outright destruction, of some coral reefs. The most popular sunscreen products contain two ingredients—oxybenzone and octinoxate—that have also been implicated in coral toxicity and will be banned. This creates a healthcare dilemma: Will the protection of coral reefs result in an increase in human skin cancers? What is new and conclusion: Concentration estimates and mechanism studies support an association—direct or indirect (via promotion of viral infection)—of sunscreens with bleaching of coral reefs. A ban on the two most common sunscreen ingredients goes into effect in Hawaii on January 1, 2021. Proponents suggest that this is a trend, just the first of many such bans worldwide; opponents warn of a dire increase in human skin cancers. As a result, alternative sunscreen compounds are being sought. Hawaii will ban two major ingredients of sunscreens. This article reviews the reasons and future directions. Hawaii recently enacted legislation that will ban the two major ingredients of the majority of commonly used sunscreens in order to protect marine ecosystems, particularly coral reefs. But sunscreens also save lives by decreasing the risk of UV‐induced skin cancers. This article reviews the issues and potential implications for healthcare providers. [ABSTRACT FROM AUTHOR]

Summary: What is known and objective: The double‐helical conformation of human DNA (hDNA) is so axiomatic that it is called the "canonical" form. Recently, though, intrastrand folds ("I‐motifs" and "G‐quadruplexes") have been identified in hDNA. These could be targets for novel drug discovery. Comment: Any interruption of the canonical form of hDNA fundamentally impacts the normal progression of transduction and translation. In particular, the synthesis of receptors and cognate protein ligands would be affected, as well as their affinity for—and signal transduction of—pharmacotherapeutic agents. Recent studies have identified normally occurring, folded structures superimposed on the usual double‐helix motif of hDNA. What is new and conclusion: The newly identified "folded DNA" structures ("I‐motifs" and "G‐quadruplexes") could represent novel drug‐discovery targets, most likely for cancer. The newly‐identified "folded DNA" structures ("I‐motifs" and "G‐quadruplexes") could represent novel drug‐discovery targets. [ABSTRACT FROM AUTHOR]

What is known and Objective: The United States Food and Drug Administration (FDA) recently issued a Drug Safety Communication requiring Boxed Warning updating and other changes in order to improve the safe use of the benzodiazepine drug class. These changes were prompted because 'The current prescribing information for benzodiazepines does not provide adequate warnings about [the] serious risks and harms associated with these medicines so they may be prescribed and used inappropriately'. Comment: The FDA Communication points out that benzodiazepines can be an important option for treating disorders for which these drugs are indicated. However, the acknowledged problems of these drugs, which historically were considered an acceptable trade‐off against their benefits, need to be reassessed in light of their widespread (over?) prescribing (for example, in 2019 an estimated 92 million benzodiazepine prescriptions were dispensed from US retail and mail‐order pharmacies). What is new and Conclusion: The FDA Communication can be viewed as an important step in reminding healthcare providers of the 'serious risks and harms associated with these medicines', and validation of such reports by patients. Importantly, the FDA Communication includes an often‐neglected aspect of benzodiazepine prescribing, namely how to discontinue use, and the perplexing protracted withdrawal syndrome experienced by some patients. The Communication advises to providers: 'No standard benzodiazepine tapering schedule is suitable for all patients; therefore, create a patient‐specific plan to gradually reduce the dosage, and ensure ongoing monitoring and support as needed to avoid serious withdrawal symptoms or worsening of the patient's medical condition'. [ABSTRACT FROM AUTHOR]

What is known and Objective: In response to rapid spread of coronavirus (SARS‐CoV‐2) and lack of vaccine or effective treatment for COVID‐19 disease, governments imposed measures that resulted in a shift from work and school to isolation at home. Studies from three countries (China, Belgium and the United States) report the consequences on traumatic bone fractures. Comment: The coronavirus pandemic has resulted in a widespread change to a relative sedentary lifestyle and decreased exposure to light (vitamin D). A consequence of the stay‐at‐home policies is a negative change in bone‐health and environmental surroundings that has led to age‐related changes in the number of traumatic bone fractures. What is new and conclusion: A consequence of stay‐at‐home policies has been a decline in bone fractures for young and middle‐aged adults; but an increase for the elderly. The trends are predicted to reverse, and present new problems, when isolation restrictions are removed. [ABSTRACT FROM AUTHOR]

Absract: What is known and Objective: About 10% of all infants are born prematurely. Almost all of those of gestational age less than about 30 weeks, and about half of those of gestational age up to about 35 weeks, are subject to unpredictable interruptions of breathing—known as "apnoea of prematurity" (AOP). We present a synopsis of the problem and point out the limited management options. Comment: A basal rate for spontaneous breathing is normally maintained by integrated action of generator cells in the brainstem and feedback from central and peripheral chemosensors. In AOP, there are intermittent periods (seconds) lacking spontaneous firing, which results in hypoxia and hypercapnia. The long‐term consequences of these interruptions in oxygen supply to tissues are not known. Although many treatment modalities are used, including drug therapy, nonpharmacologic care and mechanical intervention, there is no universally effective first‐line management for AOP. Caffeine citrate is generally the most frequently used pharmacotherapeutic agent, but its side effect profile narrows with higher doses and the upper limit is still being investigated to discern the greatest benefit‐to‐risk ratio; thus, most infants do not achieve complete resolution of apnoeas. What is new and Conclusion: Given the widespread and serious nature of the problem of AOP, there is a surprising lack of treatment options. A more consistent and effective treatment, alone or as adjunct, would be welcome. [ABSTRACT FROM AUTHOR]

What is known and objective: The sudden and extensive outbreak of coronavirus (SARS‐CoV‐2) has overshadowed another developing viral threat: the Zika flavivirus. Of particular concern is that pregnant women can pass Zika virus to the foetus, and there is a strong implication of an association between Zika virus infection and foetal microcephaly. Currently, there is no vaccine, and there is no cure. Methods: Published literature and Internet sources were searched for information related to Zika virus, its transmission, its clinical presentation and sequalae, prevention and implications (practice and regulatory) for healthcare providers. The identified English sources were reviewed, assessed and synthesized. Emphasis was placed on providing an overview of the problem, and identification of unmet needs and future directions. Results and discussion: Zika virus poses a major challenge for healthcare providers, particularly in areas unaccustomed to it, since it is transmitted to humans by the vector Aedes aegypti mosquito. The outbreak impacts every healthcare provider, because every provider is required to report cases of Zika infection to their state or local health agencies––whether the infection is confirmed or merely suspected. Since the virus has become a worldwide crisis, healthcare providers will need to work across national boundaries and medical disciplines in order to educate patients about Zika symptoms and the mosquito vector. Until further information is known, infected patients (male and female) are being advised to avoid conceiving a child. What is new and Conclusion: Until a vaccine is developed or effective treatment for Zika virus is discovered, healthcare providers must be AVP (aware, vigilant and proactive) in order to lessen the spread and impact of the implicated devastating birth defects (microcephaly) and other neurological disorders (eg Guillain‐Barré Syndrome) of this infection. Unfortunately, many knowledge gaps exist. There is an urgent need for a reliable, inexpensive diagnostic test, an effective treatment and an approved and readily available vaccine. Until a vaccine is developed or effective treatment for Zika virus is discovered, healthcare providers must be proactive to lessen its spread and impact of implicated birth defects (eg, microcephaly) and other neurological disorders (eg, Guillain‐Barré Syndrome). Unfortunately, knowledge gaps exist. There is urgent need for a reliable, inexpensive diagnostic test, effective treatment and readily available vaccine. [ABSTRACT FROM AUTHOR]