Shigehisa Kuriyama has written a brilliant study of how ancient Greek (and Greco-Roman) and Chinese medicine represented the body. Concerned with the visual and literal vocabularies of medicine and the map that they draw of the body, Kuriyama provides detailed studies of how these systems work and of how they differentiate themselves from one another. Thus, the chapter on “the origins of the muscular body” asks why ancient Greek medicine initially did not “see” the muscles, but learned eventually to do so, while ancient Chinese medicine never truly discovered the muscular system. Shigehisa Kuriyama claims that Greek medicine “learned to see” over time; building on anatomical dissection, while Chinese medicine relied on a powerful philosophy of the body that precluded anatomy. Reality testing, however, is sufficient only if there is a philosophy, which demands the accretion and change of knowledge. This is present in Greek medicine, at least until it becomes canonized in the early middle ages. Indeed, one of the most striking things about Shigehisa Kuriyama’s book is that it gives one a strong claim to understand what happens to flexible versus rigid systems of representation in different historical contexts. Thus, the representation and transmission of Greek medicine through Arabic and Hebrew sources into Latin Europe creates a canon of medical truths that exist until Vesalius. Indeed, the power of such models, as has been well noted, is such that even Vesalius, who takes Aristotle’s model of the body to task, is unable to see such anatomical features as the Fallopian tubes because of his mirror-like response to Aristotle. Only his student, Fallopius, is able to make the break. On the other hand, Chinese traditional medicine in Japan (and later in post–Republican China) amalgamates itself into Western medicine. Traditional medicine is banished as part of the Westernization of the Meiji revival, and its reappearance only after the beginning of the 20th century is in very different form. The very nature of the models used in traditional medicine shift. Thus, by the 1950s acupuncture comes to be used as anesthesia during surgical procedures. Given the refusal to open the body in traditional systems of Chinese medicine, such a use would have been literally “unthinkable” before the introduction of Western models of medical thinking.
Biomaterials are substances other than food or drugs contained in therapeutic or diagnostic systems that are in contact with tissue or biological fluids. Biomaterials play a central role in extra corporeal devices, from contact lenses to kidney dialyses, and are essential components of implants, from vascular grafts to cardiac pacemakers and fracture fixation devices. The development and availability of modern high-tech polymers allowed improving the patients care in all fields of medicine. In this course we will: Gain an overview of the use of polymeric biomaterials in medicine Discuss some examples of permanent and resorbable polymer implants in detail Take a look at legal and regulatory aspects Learn about functional and design requirements when dealing with polymers in medicine, and Look into some modern approaches how polymers improve medical implants.
Djordje S Popovic,1 Theocharis Koufakis,2 Dimitrios Patoulias,2 Anca Pantea Stoian,3 Nikolaos Papanas4 1Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia; 2Second Propaedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 3Department of Diabetes, Nutrition and Metabolic Diseases, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; 4Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, GreeceCorrespondence: Djordje S Popovic, Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Vojvodina, Medical Faculty, University of Novi Sad, Hajduk Veljkova 1, Novi Sad, 21000, Serbia, Tel +38163551606, Email pitstop021@gmail.com; djordje.popovic@mf.uns.ac.rsAbstract: Recreational diving with self-contained underwater breathing devices is gaining popularity worldwide as a sport and leisure activity. People living with type 1 diabetes mellitus (PLT1D) are no exception, although historically diabetes mellitus, especially insulin-treated, has been described as an absolute contra-indication for diving. However, based on observational data collected by the Divers Alert Network, the presence of background diabetes mellitus became only a relative contraindication for those without significant co-morbidities or long-term complications. Regarding diving activities among PLT1D, the primary concern is the risk of hypoglycaemia, especially in those with impaired awareness. Furthermore, symptoms consistent with hypoglycaemia could be confused with those originating from other factors related to diving. Although avoidance of hypoglycaemia is imperative among PLT1D practicing diving, the risk of severe hyperglycaemia should also be minimised. Continuous glucose monitoring (CGM) nowadays represents the standard of care for PLT1D, but its accuracy during diving activities is still a matter of debate. This commentary aims to summarize the existing data on accuracy, durability, and underwater performance of different CGM devices among PLT1D who engage in diving, and to call for additional research in the field. Based on available results, the application of real-time CGM still requires extreme caution since none of the existing systems has so far met the standards for accurate use in underwater conditions. Further improvements of contemporary CGM devices, validated through large-scale trials, are necessary before their widespread implementation among PLT1D practicing diving. Such advances should further enhance safety during this popular activity.Keywords: continuous glucose monitoring, diving, type 1 diabetes mellitus
Kira DiClemente-Bosco, Caroline Kuo, Goodman Sibeko
et al.
Background In South Africa, rates of HIV and alcohol use are among the highest globally, with a detrimental synergistic relationship. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based, cost-effective approach to identifying people at risk of alcohol-related problems to deliver early intervention. We developed and deployed a cascading train-the-trainer model to promote SBIRT implementation in a large nongovernmental organization offering HIV services across South Africa. Method Between 2021 and 2022, we completed preparatory activities including designing scalable training resources prior to rolling out the train-the-trainer model across two South African provinces. We conducted a comprehensive assessment of outcomes at the trainer- (knowledge, fidelity), provider- (attitudes, confidence, perceived implementation potential, adoption), and client-encounter (reach) levels over approximately one year. Results We trained 12 novice trainers who then trained 206 providers to implement SBIRT. Trainer SBIRT knowledge increased pre- to posttraining, and fidelity of training delivery was high (99.0% of elements covered across sessions). Provider attitudes, confidence, and perceived implementation potential increased over time, and 64% of providers adopted SBIRT. Reach of the model varied by component, with 41,793 clients screened by trained providers. Of those screening positive for risky alcohol use, 86% received brief intervention (BI) and 53% received referral to treatment (RT). Additionally, 15,353 clients who did not screen as having risky alcohol use received BI and 1,122 received RT. Conclusion Results indicated that the cascading training model was delivered with high fidelity, associated with improvements in all provider outcomes, and reached high numbers of clients for the screening component of the model. Rates of BI and RT delivery were moderate to high, though data suggested over-application of these elements with some clients, highlighting the tension between reach and fidelity. Lessons learned will inform future scale-out of this model in HIV service settings in low- and middle-income countries.
Diplopia or double vision has many aetiologies and often presents to the ophthalmologist. The causes of diplopia may be ocular or neurogenic in origin. Any trauma to the eyes in the form of blow-out fractures causes diplopia by damaging the third nerve. The management by the practitioners of contemporary science depends upon the extent of the nerve or muscle injury. Entrapment of muscles requires surgical intervention, whereas others are managed conservatively. The recovery rate is the least for diplopia of traumatic origin.A 50-year-old male who sought Ayurvedic treatment for diplopia in the last three months was diagnosed with partial third nerve palsy after a fracture of the left orbit. He underwent Ayurvedic therapy in the form of internal medicines such as Danadanayanadi kashaya, Ksheerabala 101, Vaishwanara churna, and external treatments such as Pratimarsha Nasya, Siro abhyanga, and Tarpana.At the end of 2 months of Ayurvedic treatment, the patient completely recovered from diplopia.Ayurvedic treatment effectively resolved diplopia in a short time. Patients can benefit from the same if treated promptly in the early stage itself. However, more extensive studies with larger samples will yield more data to prove the potential of Ayurveda in such cases.
Hanna Tania Dwi Crisanti, Rosatyani Puspita Adiati
Perubahan komitmen karyawan saat ini mengarah pada karier mereka daripada organisasi tempat mereka bekerja. Komitmen karier adalah sikap individu terhadap pekerjaan yang meliputi tujuan karier pribadi. Tujuan penelitian ini untuk mengetahui hubungan grit dan persepsi dukungan supervisor dengan komitmen karier karyawan. Partisipan penelitian ini sebanyak 87 partisipan merupakan karyawan/i berusia 24-35 tahun dan sedang bekerja penuh waktu di suatu perusahaan/organisasi. Penelitian ini menggunakan 3 skala, yakni skala Grit yang disusun oleh Duckworth, skala persepsi dukungan supervisor oleh Burns, dan skala komitmen karier oleh Carson dan Bedeian. Analisis data menggunakan bantuan software Jamovi 2.3.28. Hasil penelitian memperoleh terdapat hubungan grit dan persepsi dukungan supervisor dengan komitmen karier pada karyawan milenial. Dengan demikian, organisasi perlu mempertimbangkan pendekatan yang memfokuskan pada pengembangan personal grit karyawan serta memperkuat kualitas hubungan antara supervisor dan karyawan untuk memastikan komitmen jangka panjang karyawan terhadap karier mereka dan kesuksesan organisasi.
Georgios A. Pavlopoulos, P. Kontou, Athanasia Pavlopoulou
et al.
Abstract The latest advances in high-throughput techniques during the past decade allowed the systems biology field to expand significantly. Today, the focus of biologists has shifted from the study of individual biological components to the study of complex biological systems and their dynamics at a larger scale. Through the discovery of novel bioentity relationships, researchers reveal new information about biological functions and processes. Graphs are widely used to represent bioentities such as proteins, genes, small molecules, ligands, and others such as nodes and their connections as edges within a network. In this review, special focus is given to the usability of bipartite graphs and their impact on the field of network biology and medicine. Furthermore, their topological properties and how these can be applied to certain biological case studies are discussed. Finally, available methodologies and software are presented, and useful insights on how bipartite graphs can shape the path toward the solution of challenging biological problems are provided.
Abstract Background Unprescribed and herbal medicines use among pregnant women is a public health concern in low and middle-income countries because of the potential teratogenic effects, insufficient safety and weak drug regulatory systems. Unprescribed and herbal medicines are common among pregnant women in Nigeria, and only a few researchers have documented the prevalence and the risk factors. However, evidence on the associated pregnancy outcomes is still lacking. We assessed the prevalence, predictors and pregnancy outcomes of unprescribed and herbal medicines use among pregnant women in Ibadan, Nigeria. Methods This study was a component of the Ibadan Pregnancy Cohort Study, a prospective cohort study, among pregnant women in Ibadan, Nigeria, who were enrolled at ≤ 20 weeks gestation at their first antenatal visit and followed up till delivery. In all, 571 women participated in the maternal drug use assessment during the third trimester using a pretested interviewer-administered questionnaire. The primary outcomes were unprescribed and herbal medicines use and pregnancy outcomes, secondary outcomes, were abstracted from medical records. The predictors assessed included sociodemographic, obstetric, antenatal care utilization, and lifestyle characteristics. Bi-variate logistic and Poisson regression analyses were used to evaluate the predictors and relative risk for the pregnancy outcomes of unprescribed and herbal medicines at 5% significance. Results The prevalence of unprescribed and herbal medicine use was 31.9% and 21.7%, respectively. On bivariate analysis, the significant predictors of unprescribed medicine (which were protective) were tertiary education, increasing income, adequate antenatal care (≥ 4 visits), and at least two doses of sulfadoxine-pyrimethamine. However, high parity and having an antenatal admission increased the risk. However, after adjusting for confounders, the significant factors associated with unprescribed medicines were; tertiary education (AOR) = 0.23; 95% CI: (0.06 – 0.95); p-value: 0.043] and obtaining at least two doses of sulfadoxine-pyrimethamine [AOR = 0.33; 95% CI: (0.29 – 3.60); p-value: 0.048]. For herbal medicines, the predictors were similar to unprescribed drugs. However, after adjusting for confounders, none was significant for herbal medicines. Unprescribed and herbal medicines were not significantly associated with pregnancy outcomes. Conclusions Unprescribed and herbal medicines use were common among pregnant women in Ibadan, Nigeria, particularly among women with low economic status and those with poor utilization of antenatal care services. These significant predictors can be targeted for public health intervention. Specifically, health education that discourages the use of unprescribed and herbal medications to pregnant women during antenatal care.
Melissa Martins Souto, Micael Doria de Andrade, Rosangela Andrade Aukar de Camargo
Nascimento pré-termo é aquele que ocorre com menos de 37 semanas de idade gestacional. Considera-se com baixo peso o bebê que nasce com menos de 2.500 gramas. Ambos são fatores de risco para o desenvolvimento de afecções perinatais. Embora existam estigmas envolvidos no nascimento de um bebê com essas condições – tais como falta de informações dos familiares –, o Método Canguru, como parte da educação em saúde, pode contribuir para mitigar mortalidades nesses recém-nascidos. Tais estratégias educativas podem ser realizadas pela utilização de tecnologias educacionais, como infográficos animados norteados por roteiros. O presente estudo objetivou a concepção e a execução da elaboração do conteúdo (roteiro) para o desenvolvimento de infográfico animado sobre o Método Canguru. Trata-se de um estudo metodológico. No roteiro, após análise documental e de similares (vídeos semelhantes na rede), delimitou-se o tema Método Canguru, com descrição de suas etapas e vantagens, focado em famílias de recém-nascidos pré-termo e/ou com baixo peso, hospitalizados em Unidades de Terapia Intensiva. Articulou-se a criação da identidade dos personagens com a locução e auxílios visuais, possibilitando explorar diferentes formas de aprendizagens e melhorar a capacidade de recepção das informações. Totalizaram-se 22 cenas que abordam a apresentação das personagens e dos conceitos, a descrição de etapas, as atribuições do enfermeiro neste contexto, as vantagens da realização da posição canguru e a importância do acompanhamento do bebê e da família pela Atenção Primária à Saúde. Apesar da complexidade que envolve a elaboração de recursos educacionais, foi possível construir um roteiro para o desenvolvimento do infográfico animado sobre o Método Canguru com informações que buscam atender às necessidades do público-alvo. Espera-se que este estudo possa fomentar e ampliar a prática da utilização de recursos educacionais para o cuidado qualificado do recém-nascido pré-termo e promover a reflexão de profissionais da saúde-gestores-comunidade sobre o tema.
Miscellaneous systems and treatments, Public aspects of medicine
Background To date, nephrotoxicity in new drug development has been evaluated through two-dimensional culture of representative cell lines, such as HK-2 and human proximal tubule epithelial cells (hPTECs). Approximately 20% of new drugs that were safe in preclinical studies were withdrawn from clinical trials due to nephrotoxicity, which means the current renal cell lines used in preclinical trials have limitations for the accurate detection of nephrotoxicity. Methods and Results Here, we established proximal tubule cell lines from immortalized mixed primary renal cells and generated functional proximal tubule cell spheroids, which expressed all apical basolateral transporters and showed epithelial polarity. Moreover, they showed a more sensitive drug response than hPTECs, which have been commonly used as in vitro kidney models. Conclusion Taken together, the proximal tubule cells described in this study provide a more stable, reproducible, and accurate in vitro kidney model for predicting nephrotoxicity, which could help early compound development.
Biotechnology, Miscellaneous systems and treatments
Background: Different Traditional Chinese Medicine (TCM) in the format of granules, such as Kanggan Granules (KangGs), Kouyanqing Granules (KouGs), Lianhua Qingwen Granules (LQGs), Qingkailing Granules (QGs) and Xiao'er Qingjie Granules (XQJGs), collectively named Yinhua-based herbal granules (YH-HGs) have been widely used in the management of pediatric outpatients with herpangina. Few head-to-head randomized controlled trials (RCTs) have compared the efficacy of these agents. This network meta-analysis (NMA) was conducted to indirectly compare the efficacy of YH-HGs. Methods: This systematic review and fixed-effect NMA was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) extension statement for NMA. RCTs assessing the efficacy and safety of YH-HGs in children that were also receiving ribavirin as the conventional therapy were searched from eight databases and two trial registers up to Jan 13, 2022. The primary outcome was total effectiveness rate (TER). The secondary outcomes were total adverse events (TAEs) and the time to symptom improvement of fever, vesicles, pain and salivation. Relative risk (RR) and weighted mean difference with 95% confidence intervals (CIs) were estimated by direct pairwise meta-analysis (MA) and NMA. Results: A total of 10 RCTs, enrolling 1 017 pediatric patients, were included. YH-HGs were better than no medication (NM) in TER (RR = 1.22, 95%CIs, 1.16 – 1.28) by direct pairwise MA, in which KangGs (RR = 1.24, 95%CIs, 1.05 – 1.47), KouGs (RR = 1.17, 95%CIs, 1.08 – 1.27), LQGs (RR = 1.24, 95%CIs, 1.14 – 1.35), QGs (RR = 1.33, 95%CIs, 1.11 – 1.58) and XQJGs (RR = 1.18, 95%CIs, 1.00 – 1.40) were also more efficient than NM. As for secondary outcomes, YH-HGs was associated with a 103% increased risk of TAEs compared to NM, but no significant differences were found. YH-HGs has a more positive symptom improvement effect than NM in fever, vesicles, pain and salivation. The ranking results showed that QGs (79.2%) had the highest probability ranking first in TER and KangGs (63.6%) ranked as the second, followed by LQGs (52.4%), XQJGs (50.3%), KouGs (49.7%), and NM (4.9%) at last. Conclusions: Our findings support the better efficacy of YH-HGs than NM as regards TER. QGs, KangGs, LQGs, XQJGs, KouGs remain superior to NM and their clinical choice should depend on the patient's conditions to improve symptoms better for the different effects. Given the limitations of NMA, head-to-head RCTs with high-quality are needed.
Nicolae BACINSCHI, Lorina VUDU, Stela BACINSCHI-GHEORGHITA
et al.
Туберкулез — инфекционное заболевание, поражающее практически все органы, в том числе и щитовидную железу. Одновременно изменение функции щитовидной железы может повысить восприимчивость к инфекции Mycobacterium tuberculosis. Лечение туберкулеза, особенно препаратами второго ряда, может обуславливать раз- витие гипотиреоза. Установлено, что рифампицин, этионамид, протионамид и парааминосалициловая кислота являются одними из наиболее распространенных противотуберкулезных препаратов, ответственных за развитие гипотиреоза. Эти препараты могут вызывать дисфункцию щитовидной железы путем увеличения метаболизма и клиренса тиреоидных гормонов за счет индукции ферментов цитохрома Р-450, нарушения регуляции поглощения йода и синтеза тиреоидных гормонов, изменения действия гормонов на уровне рецепторов и передачи внутрикле- точного сигнала. Лечение этими препаратами требует контроля функции щитовидной железы во время лечения, особенно в первые 3 месяцa, а также в пост-лечебный период. Развитие клинического и/или субклинического гипотиреоза потребует применения адекватных доз левотироксина на фоне противотуберкулезного лечения.
Katarzyna Wódka, Alicja Michalczyk, Agnieszka Jankowicz-Szymańska
Aim of the study: The aim of the study was to assess the relationship between the position of the sacrum, lumbar and thoracic spine and the mobility of the trunk in the sagittal plane in young women and men.
Material and methods: 64 students (33 women and 31 men) were studied. The mean age in the study group was 22.94 ± 1.51 years. The following tests were performed on each subject once: measurement of height and weight, assessment of spinal alignment and mobility in the sagittal plane using Zebris Pointer.
Results: The results obtained were analyzed using appropriate statistical tools. Statistically significant correlations were obtained: in the alignment of the sacrum in relation to the lumbar spine (strong correlation), in the alignment of the lumbar spine in relation to the thoracic spine and, in the male group only, between the alignment of the thoracic spine and mobility in the direction of flexion in the thoracic segment (moderate correlation).
Conclusions: In women, horizontal sacral alignment coexisting with deepened lordosis was most frequently observed. In addition, women were more likely to have a deepened thoracic kyphosis, less range of motion in the direction of thoracic flexion and extension, and greater mobility in the direction of lumbar flexion and extension than men. In men, the vertical alignment of the sacrum was accompanied by a shallowing of the physiological lordosis. In addition, in this group, a decrease in lordosis influenced an increase in movement to flexion in the thoracic spine. When planning a physiotherapy exercise program for a person in whom abnormalities in the alignment of the lumbopelvic complex have been noted, an individual exercise program should be selected. The study should take into account not only the evaluation of the alignment of the lumbosacral spine, but also the mobility of the segments above and below the examined area taking into account intergender differences.
Personalized Medicine (PM) has shifted the traditional top-down approach to medicine based on the identification of single etiological factors to explain diseases, which was not suitable for explaining complex conditions. The concept of PM assumes several interpretations in the literature, with particular regards to Genetic and Genomic Medicine. Despite the fact that some disease-modifying genes affect disease expression and progression, many complex conditions cannot be understood through only this lens, especially when other lifestyle factors can play a crucial role (such as the environment, emotions, nutrition, etc.). Personalizing clinical phenotyping becomes a challenge when different pathophysiological mechanisms underlie the same manifestation. Brain disorders, cardiovascular and gastroenterological diseases can be paradigmatic examples. Experiences on the field of Fondazione Policlinico Gemelli in Rome (a research hospital recognized by the Italian Ministry of Health as national leader in “Personalized Medicine” and “Innovative Biomedical Technologies”) could help understanding which techniques and tools are the most performing to develop potential clinical phenotypes personalization. The connection between practical experiences and scientific literature highlights how this potential can be reached towards Systems Medicine using Artificial Intelligence tools.