Contemporary Medical Practice Research Articles

Hippocrate’s Contribution Exploring the Tashrih-Al-Nizam-E-Baul (Anatomy of Urinary System): A Comprehensive Review

Hippocrates' early contributions to the understanding of urinary physiology continue to inform contemporary research and medical practice, emphasizing the enduring relevance of his observations in the history of anatomical studies. Hippocrates significantly contributed to understanding the kidneys and urinary system, including the urethra. Furthermore, he recognized the tubes carrying urine from the kidneys to the bladder and the bladder's role in storing and expelling urine. However, his knowledge of blood vessels and the urethra remains limited. Hippocrates, a key figure in the development of clinical nephrology, outlined four renal diseases, including kidney colic, renal tuberculosis, renal vein thrombosis, bilateral papillary necrosis, and chronic suppurative renal infection. In addition, he also described bladder stones, urinary conditions like painful, difficult urination, incontinence, urinary retention, renal colic, and renal tuberculosis. Treatment for urinary disorders included warm applications, baths, plant-derived diuretics, diet, and incision over the kidneys. Urine symptoms included bubbles on the surface, colorless urine, and sudden increases of blood in urine. The Corpus Hippocraticum, a study of the urinary tract, has significantly contributed to urology, particularly in uroscopy and renal stone formation. The study of the urinary tract provides valuable insights into anatomy, physiology, etiology, and treatment of urological diseases. Hippocrates introduced the concept of high-risk operations, advising specialists to perform them and avoiding untrained healers. He differentiated between upper and lower urinary tract infections, identifying blood clots in urine as kidney discharge and bladder infections as bladder stones. This article highlights the fundamental contributions of Hippocrates to the field of nephrology and to the understanding of renal anatomy and shows how his teachings influenced later medical practices and advances in the understanding of renal function and pathology. This review aims to uncover the significance they hold in the historical literature, showcasing the historical impact of his pioneering work on the Tashrih-al-Nizam-e-Baul (Anatomy of Urinary System).

Use of Virtual Reality and 3D Models in Contemporary Practice of Cardiology.

To provide an overview of the impact of virtual and augmented reality in contemporary cardiovascular medical practice. The utilization of virtual and augmented reality has emerged as an innovative technique in various cardiovascular subspecialties, including interventional adult, pediatric, and adult congenital as well as structural heart disease and heart failure. In particular, electrophysiology has proven valuable for both diagnostic and therapeutic procedures. The incorporation of 3D reconstruction modeling has significantly enhanced our understanding of patient anatomy and morphology, thereby improving diagnostic accuracy and patient outcomes. The interactive modeling of cardiac structure and function within the virtual realm plays a pivotal role in comprehending complex congenital, structural, and coronary pathology. This, in turn, contributes to safer interventions and surgical procedures. Noteworthy applications include septal defect device closure, transcatheter valvular interventions, and left atrial occlusion device implantation. The implementation of virtual reality has been shown to yield cost savings in healthcare, reduce procedure time, minimize radiation exposure, lower intravenous contrast usage, and decrease the extent of anesthesia required. These benefits collectively result in a more efficient and effective approach to patient care.

Best Practices for Point of Care Ultrasound: An Interdisciplinary Expert Consensus.

Despite the growing use of point of care ultrasound (POCUS) in contemporary medical practice and the existence of clinical guidelines addressing its specific applications, there remains a lack of standardization and agreement on optimal practices for several areas of POCUS use. The Society of Point of Care Ultrasound (SPOCUS) formed a working group in 2022 to establish a set of recommended best practices for POCUS, applicable to clinicians regardless of their training, specialty, resource setting, or scope of practice. Using a three-round modified Delphi process, a multi-disciplinary panel of 22 POCUS experts based in the United States reached consensus on 57 statements in domains including: (1) The definition and clinical role of POCUS; (2) Training pathways; (3) Credentialing; (4) Cleaning and maintenance of POCUS devices; (5) Consent and education; (6) Security, storage, and sharing of POCUS studies; (7) Uploading, archiving, and reviewing POCUS studies; and (8) Documenting POCUS studies. The consensus statements are provided here. While not intended to establish a standard of care or supersede more targeted guidelines, this document may serve as a useful baseline to guide clinicians, leaders, and systems considering initiation or enhancement of POCUS programs.

Comparison of Performance in Diagnosis and Characterization of Breast Lesions: Contrast-Enhanced Mammography Versus Breast Magnetic Resonance Imaging

IntroductionIn contemporary medical practice, magnetic resonance imaging (MRI) is the most sensitive modality for detecting breast cancer. Contrast-enhanced mammography (CEM), a relatively recent technology, represents another contrast-enhanced imaging technique that has the potential to serve as an alternative to breast MRI. Our main goal is to compare the diagnostic accuracy including assessment of sensitivity and specificity of these 2 contrast-enhanced breast imaging methods, CEM and MRI, in the diagnosis and characterization of breast lesions. Material and methodsOur prospective study included patients who were clinically suspected of malignancy and/or had suspicious findings detected by mammography or ultrasound. A total of 116 patients were included, and both CEM and MRI examinations were performed on all patients. All CEM examinations were conducted at our institution, while 56.89% of all MRI examinations were carried out at external centers. While histopathological results were accessible for all malignant lesions, the final diagnosis for 80.5% of benign lesions was established through typical imaging findings and adequate follow-up. ResultsThis study encompassed a total of 219 lesions, with 125 out of 219 (57.07%) malignant lesions and 94 out of 219 (42.92%) benign lesions. The sensitivity and specificity values were 98.40% and 81.91%, respectively, for CEM, and 100% and 75.33%, respectively, for MRI. Moreover, CEM showcased comparable performance to MRI in evaluating women with dense breasts. ConclusionCEM and MRI were compared for breast lesion diagnosis, with MRI showing higher sensitivity and CEM higher specificity; however, the differences were not statistically significant.

Seeking American Society of Clinical Oncology‐Quality Oncology Practice Initiative (ASCO‐QOPI) certification in a northern New England rural health system and cancer care network

AbstractIn 2006 following several years of preliminary study, the American Society of Clinical Oncology (ASCO) launched the Quality Oncology Practice Initiative (QOPI). This cancer‐focused quality initiative evolved considerably over the next decade‐and‐a‐half and is expanding globally. QOPI is undoubtedly the leading standard‐bearer for quality cancer care and contemporary medical oncology practice. The program garners attention and respect among federal programs, private insurers, and medical oncology practices across the nation. The MaineHealth Cancer Care Network (MHCCN) has undergone expansive growth since 2017. The network provides cancer care to more than 70% of the cases in Maine in a largely rural health system in Northern New England. In fall 2020, the MHCCN QOPI project leadership, following collaborative discussions with the ASCO‐QOPI team, elected to proceed with a health system–cancer network‐wide QOPI certification. Key themes emerged over the course of our two‐year journey including: (1) Developing a highly interprofessional team committed to the project; (2) Capitalizing on a single electronic medical record for data transmission to CancerLinQ; (3) Prior experience, especially policy development, in other cancer‐focused accreditation programs across the network; and (4) Building consensus through quarterly stakeholder meetings and awarding Continuing Medical Education (CME) and American Board of Medical Specialists (ABMS) Maintenance of Certification (MOC) credits to oncologists. All participants demonstrated a genuine spirit to work together to achieve certification. We report our successful journey seeking ASCO‐QOPI certification across our network, which to our knowledge is the first‐of‐its‐kind endeavor.

Review on "Herbal Preparations from Ayurveda used to treat Rheumatoid Arthritis"

Ayurveda is a natural medicine system that originated in India over 3,000 years ago. The name "Ayurveda" (science or knowledge) is derived from the Sanskrit words Ayur (life) and Veda. Thus, the name Ayurveda, which means "knowledge of life." The popularity of Ayurveda, or traditional. Since most patients begin taking conventional medications as soon as they are diagnosed, ayurvedic therapies are usually administered in combination with or after orthodox medical techniques. To properly grasp the potential effect of food, spices, and medicinal plants, one must have a thorough understanding of their actions. Realizing the potential of Ayurvedic medicine and philosophy and incorporating it into contemporary medical practice is crucial. There are some significant differences between the mechanisms of action of synthetic pharmaceuticals and single constituents and those of polyherbal treatments and their extracts. Despite being based on natural herbal elements, the safety of ayurvedic treatments depends on how they are delivered, taking into account the needs of the individual and their specific sickness circumstances. Many contemporary drugs are derived from the botanicals used in Ayurveda and other traditional medicinal systems. It is expected that a significant step toward resolving some of the current challenges in treating complex disorders like arthritis with only modern pharmaceuticals would be the confirmation of a combined therapy strategy (Ayurveda and contemporary medicine) with improved efficacy and safety.

Injectable and Thermosensitive Hydrogel with Platelet-Rich Plasma for Enhanced Biotherapy of Skin Wound Healing.

The rapid and effective healing of skin wounds resulted from severe injuries and full-layer skin defects remains a pressing clinical challenge in contemporary medical practice. The reduction of wound infection and rapid healing is helpful to rebuild and repair skin tissue. Here, a thermosensitive chitosan-based wound dressing hydrogel incorporating β-glycerophosphate (GP), hydroxy propyl cellulose (HPC), graphene oxide (GO), and platelet-rich plasma (PRP) is developed, which exhibits the dual functions of antibacterial properties and repair promotion. GP and HPC enhance the mechanical properties through forming hydrogen bonding connection, while GO produces local heat under near-infrared light, leading to improved blood circulation and skin recovery. Notably, antibacterial properties against Pseudomonas aeruginosa, and control-release of growth factors from PRP are also achieved based on the system. In vitro experiments reveal its biocompatibility, and ability to promote cell proliferation and migration. Animal experiments demonstrate that the epithelial repair and collagen deposition can be promoted during skin wound healing in Sprague Dawley rats. Moreover, a reduction in wound inflammation levels and the improvement of wound microenvironment are observed, collectively fostering effective wound healing. Therefore, the composite hydrogel system incorporated with GO and PRP can be a promising dressing for the treatment of skin wounds.

Foucault and Clinical Photography: An Analysis and Mitigation of the Clinical Gaze in Pediatric Craniofacial Plastic Surgery

While objectification in medicine has been extensively critiqued as a philosophical concept dating back to the Ancient Greeks and contemporarily popularized by Michel Foucault, the impact of objectification through clinical photography in plastic surgery is often overlooked. Plastic surgery patients are by necessity subjected to the clinical gaze through clinical photography, which may lead to experiences of dehumanization and alienation from their physicians and surgeons. In this essay, we explore the concept of the clinical gaze in clinical photography from a structured philosophical lens, and offer one potential answer to this problem. First, we draw upon Foucault’s well-known and monumental critique of contemporary Western medical practice from Birth of the Clinic alongside a brief history of clinical photography to illustrate the problem of the “clinical gaze.” Then, we argue that mitigating the clinical gaze is critical for the flourishing of patients in general and plastic surgery patients in particular. Finally, we offer our attempt to mitigate the clinical gaze that was conducted by the Craniofacial Anomalies Program at the University of Michigan in 2014 as a demonstration of an upending of the power dynamic usually at play.

Common differential diagnosis of low back pain in contemporary medical practice: a narrative review.

With a wide range of etiologies, low back pain (LBP) presents a true clinical challenge, finding its origins both in intrinsic spinal and systemic conditions, as well as referred ones. This review categorizes the LBP into these three groups and aims to offer a comprehensive look at the tools required to diagnose and differentiate them. The intrinsic etiologies are based on conditions that affect the musculoskeletal components of the lumbar spine, such as intervertebral disc disease, stenosis, muscular imbalance, and facet joint degeneration. The systemic causes usually extend beyond local structures. Such are the cases of neoplasia, infections, and chronic inflammation. The diagnosis is rendered even more complex by adding the referred pain, which only manifests in the lower back yet arises in more distant locations. By synthesizing the literature that encompasses the problem, this review aims to augment the understanding of the differential diagnoses of LBP by showcasing the subject's nuances. This categorization provides a structured approach to a patient-centered diagnosis, which could facilitate the medical practitioners' efforts to navigate this pathology more effectively.

Using Nutraceuticals to Help Manage Traumatic Spinal Cord Injury.

Traumatic spinal cord injury (TSCI) is a significant public health challenge that has an adverse impact on functional independence, quality of life, and life expectancy. Management of people's chronic conditions is a key aspect of contemporary medical practice. Our study was an open label, single arm, prospective pilot study to evaluate the feasibility of treating people with TSCI. The study intervention was treatment with oral selenium and vitamin E. Participants were 18 years or older and experienced a TSCI at least one year prior to enrollment. Daily doses of 50 mcg of selenium and 400 IU of vitamin E were administered. Participants had radiologic (MRI tractography) and clinical (ASIA) assessments prior to initiating treatment, and these assessments were repeated after one year of treatment. Four subjects completed the full twelve-month study. Adherence, based on pill counts, was approximately 75% in all subjects. There were no adverse events related to study medications. During the treatment period, subjects reported improvement in certain symptoms. There was no significant difference in ASIA scores before and after the intervention. Combination treatment with vitamin E and selenium has been demonstrated as safe for TSCI patients. It is possible to use DTI values to locate the epicenter of a lesion as well as gauge the extent of injury. MRI tractography may serve as a meaningful surrogate endpoint. The results of this study suggest that it is feasible to conduct a larger long-term clinical trial to evaluate the efficacy of combination treatment of TSCI.

Application of the MMPI-2 inventory in the differential diagnosis of psychotic disorders – based on profile analysis of a patient diagnosed with persistent delusional disorder and personality disorder

Aim: Paranoid states or traits can be present in various mental disorders; hence, their clarification is valuable for establishing a reliable nosological diagnosis. Clinical practice and literature on the subject highlight a range of defence mechanisms specific to the discussed nosological group. These mechanisms can impede the process of psychiatric and psychotherapeutic diagnosis and treatment. In contemporary evidence-based medical practice, the prevalent clinical approach is based on qualitative methods (e.g. free interviews and observations) complemented by standardised diagnostic tools. This approach assists the clinician in supplementing, organising, and objectifying clinical data related to the patient’s mental state. It is particularly beneficial for handling data that may be uncertain or unavailable in an observational study for various reasons. The article presents insightful and pragmatic theoretical, empirical, and case-related information on the potential application of the Minnesota Multiphasic Personality Inventory (MMPI-2) in the psychological diagnosis of patients with persistent delusional disorders. Methods: The paper explores theoretical issues and analyses a case study involving a female patient with a suspected diagnosis of delusional disorder and co-occurring personality disorder. In the case study, the authors employed qualitative methods, including observation and free psychological interview, and supplemented clinical data with insights gained through the use of a standardised psychometric method: the MMPI-2. Reflections and practical recommendations are divided into two groups. One group comprises the potential applications of the MMPI-2 in clinical psychological diagnosis. The other focuses on the importance of the diagnostic alliance and its roles in the process of planning the psychological diagnosis in patients with delusional disorders.

Cosmetic psychiatry: A concept in urgent need of consideration.

To explore the concept of, ethics surrounding, and arguments for and against cosmetic psychiatry. Cosmetic psychiatry may be defined as the science and practice of interventions that subjectively enhance the mental states of healthy people. Cosmetic medicine (including surgery) is a professionally and socially accepted part of contemporary medical practice; cosmetic psychiatry is not. Like cosmetic medicine, there are significant risks associated with cosmetic psychiatry. There is an urgent need for a broader conversation about this emerging clinical reality.

Emergence of a New Era in Orthopaedic and Spine Medicine: Advancements and Specialization in Pakistan's Healthcare Landscape

In a remarkable transformation, the landscape of medical science, including Orthopaedic and Spine care, is rapidly evolving. Even in regions like Pakistan, characterized as third-world countries, healthcare is swiftly adopting the latest techniques, technologies, and research predominantly originating from the Western world. The origins of Orthopaedic Surgery in Pakistan trace back to the era when General Surgeons initially handled these responsibilities. However, the true development of Orthopaedic specialization began in the 1970s when the necessity for dedicated Orthopaedic treatment became evident. This marked the inception of the Orthopaedic era in the country. By the early 2000s, many medical professionals opted for this specialization, leading to a saturation point that paved the way for sub-specializations within Orthopaedics. These sub-specialities include Periotic, Trauma, Hand, Oncology, Arthroplasty, Sports, and Spine.1 Between 2000 and 2015, these sub-specialties also progressed to a saturation point, prompting a demand for even more specialized expertise. Over the past 5 to 8 years, each sub-speciality has further fragmented, with individuals or teams dedicated to refining systems that provide superior management of pathologies, thus enhancing prognoses and patient outcomes.2 This evolution has seen the emergence of both sub-specialties and super-specialties, reflecting the contemporary medical practice needs. The trajectory is clear: as exposure and practical experience accumulate, a cadre of experts will naturally emerge within these specialized domains. The domain of Spine specialization, once regarded with apprehension due to its challenging nature and variable outcomes, has been revolutionized by integrating cutting-edge technology, advanced surgical techniques, and in-depth research. Distinct categories within the Spine speciality have emerged, spanning Trauma, Oncology, Deformity Correction, Degenerative Spine, and Infection.3 These intricate surgeries are now performed using minimally invasive techniques, informed by meticulous research prioritizing anatomical precision. These advancements involve smaller incisions, real-time X-ray guidance, and even endoscopic approaches for enhanced operative field visualization. This curtails inflammatory responses and expedites patient recovery, facilitating earlier discharge from medical facilities. A noteworthy addition to Pakistan’s Spine surgery landscape is the introduction of Endoscopic Spine Surgery. Over the past half-decade, many Neuro and Orthopaedic Spine Surgeons have sought training in this cutting-edge super-specialty. The procedure offers substantial advantages such as same-day patient discharge and quicker return to normal routines. Presently, only a handful of centres in the country provide this innovative treatment modality, marking a significant stride in Spine care.

Progress in understanding and treating idiopathic pulmonary fibrosis: recent insights and emerging therapies.

Idiopathic pulmonary fibrosis (IPF) is a long-lasting, continuously advancing, and irrevocable interstitial lung disorder with an obscure origin and inadequately comprehended pathological mechanisms. Despite the intricate and uncharted causes and pathways of IPF, the scholarly consensus upholds that the transformation of fibroblasts into myofibroblasts-instigated by injury to the alveolar epithelial cells-and the disproportionate accumulation of extracellular matrix (ECM) components, such as collagen, are integral to IPF's progression. The introduction of two novel anti-fibrotic medications, pirfenidone and nintedanib, have exhibited efficacy in decelerating the ongoing degradation of lung function, lessening hospitalization risk, and postponing exacerbations among IPF patients. Nonetheless, these pharmacological interventions do not present a definitive solution to IPF, positioning lung transplantation as the solitary potential curative measure in contemporary medical practice. A host of innovative therapeutic strategies are presently under rigorous scrutiny. This comprehensive review encapsulates the recent advancements in IPF research, spanning from diagnosis and etiology to pathological mechanisms, and introduces a discussion on nascent therapeutic methodologies currently in the pipeline.

A MANAGEMENT OF VICHARCHIKA WITH ARKAHARIDRA OIL- A CASE REPORT

Vicharchika is one of the most common skin diseases. Vicharchika can be co-related with eczema, which is a form of dermatitis or inflammation of the upper layers of the skin. The term eczema is broadly applied to a range of persistent or recurring skin rashes characterized by redness, skin edema, itching, and dryness, with possible crusting, flaking, blistering, cracking, oozing, or bleeding. Areas of temporary skin discoloration are sometimes characterized as healed lesions, though scarring is rare. Long-standing eczema is often dry and is characterized by thickened, scaling skin with hyper pigmentation and visible crisscross markings (lichenification). No satisfactory treatment is available in contemporary medical practice except antihistamines and topical steroids. A patient approached OPD with chief complaints of edema, blackish skin lesions, with intense itching at the dorsum of both ears. A remarkable improvement in the condition was observed with the local application of Arkaharidra taila in a span of 2 weeks

Resilient Hospital Design: From Crimea War to COVID-19.

Serious COVID-19 nosocomial infection has demonstrated a need to design our health services in a different manner. Triggered by the current crisis and the interest in rapid deployable hospital, this article discusses how hospital building layouts can be improved to streamline the patient pathways and thus to reduce the risk of hospital-related infections. Another objective of this work is to explore the possibility to develop flexible and scalable hospital building layouts through modular construction. This enables hospitals to better cope with different future demands and thereby enhance the resilience of the healthcare facilities. During the first wave of COVID-19, approximate one-seventh to one-fifth COVID-19 patients and majority of infected healthcare workers acquired the disease in NHS hospitals. Similar issues emerged during the Crimean War (1853-1856) when more soldiers died from infectious diseases rather than of battlefield casualties in Scutari Hospital. This led to an important collaborative work between Florence Nightingale, who looked into this problem statistically, and Isambard Kingdom Brunel, who designed the rapid deployment Renkioi Hospital which yielded a death rate 90% lower than that in Scutari Hospital. While contemporary medical research and practice have moved beyond Nightingale's concept of contagion, challenges of optimizing hospital building layouts to support healing and effectively combat nosocomial infections still pose elusive problems that require further investigation. Through case study investigations, this article evaluates the risk of nosocomial infections of airborne transmissions under different building layouts, and this provides essential data for infection control in the new-build or refurbished healthcare projects. Improved hospital layout can be achieved through reconfiguration of rooms and concourse. Design interventions through evidence-based infection risk analysis can reduce congestion and provide extra separation and compartmentalization which will contribute the reduced nosocomial infection rate. A resilient hospital shall be able to cope with unexpected circumstances and be flexible to change when new challenges arise, without compromising the safety and well-being of frontline medical staff and other patients. Such an organizational resilience depends on not only flexible clinical protocols but also flexible hospital building layouts. The latter allows hospitals to get better prepared for rapidly changing patient expectations, medical advances, and extreme weather events. The reconfigurability of an existing healthcare facility can be further enhanced through modular construction, standardization of building components, and additional space considered.

Search better and you will find more: an important lesson in endoscope contamination

Endoscopy is an indispensable part of contemporary medical practice. The development of new diagnostic and therapeutic techniques has broadened its application, and the number of endoscopies continues to rise [1]. That is a trend that is very likely to continue.

Surviving COVID-19: Biopsychosocial Impacts, Death Anxiety, and Coping Strategies.

As the COVID-19 pandemic erupted, attempts to contain the spread of the virus took two concurrent forms, including mobility restrictions (aka lockdowns) and the race to produce a vaccine. However, it is quite striking that, amidst both the lockdown and the race to produce a vaccine, the question of how COVID-19 survivors/patients coped with the disease has not received the degree of attention it deserved. To navigate this issue, we employed a sample consisting of 100 COVID-19 survivors; this paper explores the relationship between the biopsychosocial (BPS) impacts of COVID-19, death anxiety, and coping strategies. In this context, the mediating role of death anxiety is placed in the spotlight. The analysis reveals a significant positive association between the BPS impact of COVID-19 and death anxiety and a significant negative association between death anxiety and coping strategies among COVID-19 survivors. Thus, death anxiety mediates the relationship between the BPS impact and the coping strategies that COVID-19 survivors adopt. Given the general recognition of the validity of the BPS model in contemporary medical science and practice, a thorough examination of COVID-19 survivors and their experiences related to surviving is necessary to match the challenges of today, including the increased probability of pandemics.

What are side effects?

Side effects are ubiquitous in medicine and they often play a role in treatment decisions for patients and clinicians alike. Philosophers and health researchers often use side effects to illustrate issues with contemporary medical research and practice. However, technical definitions of 'side effect' differ among health authorities. Thus, determining the side effects of an intervention can differ depending on whose definition we assume. Here I review some of the common definitions of side effect and highlight their issues. In response, I offer an account of side effects as jointly (i) unintended and (ii) effects due to the causal capacities or invariances of an intervention. I discuss (i) by examining the intentions or reasons behind therapeutic interventions, and I discuss (ii) by appealing to a manipulationist model of causation. The analysis here highlights that side effects are conceptually distinct from related outcomes like adverse events, adverse drug reactions, and placebo effects. The analysis also allows for reflection on the utility of 'side effect' as a technical term in medical research and practice.

Validity of biopsychosocial model of intervention in contemporary medical practice: Walking a few extra miles

Validity of biopsychosocial model of intervention in contemporary medical practice: Walking a few extra miles