Are Ancestral Medical Practices the Future Solution to Today's Medical Problems?

Our cells and organs are threatened and, in most cases, constantly subjected to the aggression of numerous situations, both endogenous, characterized by unfavorable genetics, and exogenous, by deficient or inadequate nutrition, and even by a hostile environment; in most cases, they ultimately cause a cascade of degenerative and cardiovascular diseases, cancer, and infections, as well as those related to the metabolic syndrome, all of which eventually generate irreversible damage to the organism and, consequently, a significant deterioration in its survival [...].

From Early Pharmacology to Recent Pharmacology Interventions in Acute Coronary Syndromes: JACC State-of-the-Art Review.

This focus seminar will take the reader through the history and pivotal trials that have formed the current state-of-the-art management for acute coronary syndromes. The identification of a ruptured plaque with thrombus formation and subsequent occlusion or downstream embolization in the coronary artery was the key to developing new and effective treatment strategies. The traditional wait-and-see approach with prolonged bedrest was replaced in the 1980s by immediate pharmacological reperfusion of the occluded coronary artery and long-term aspirin to prevent reinfarction. Mechanical reperfusion with percutaneous coronary intervention with stenting and more intense platelet inhibition with P2Y12 inhibitors further improved outcomes from early 2000s. Adjunctive treatment regimens, including anticoagulants, statins, and neurohormonal inhibition, were found to further reduce mortality and prevent new infarctions. Taken together, the use of new combined pharmacological and interventional treatment strategies has led to a remarkable decrease in 1-year mortality from around 22% in 1995 to around 11% by 2014.

Publication-Based Academic Interest in Drugs and Techniques for Treatment of Postoperative Pain, 1975-2015.

PURPOSE: The aim of this study was to determine how drugs and their administration techniques, introduced over the past 40 years and still popular now, influenced publication-based academic interest in the treatment of postoperative pain. METHODS: Specific scientometric indices-popularity index (PI), top journal selectivity index (TJSI), and index of change (IC)-were used. Of the 61 terms searched, only those that had a PI value ≥1.0 during the 2011-2015 period were selected. They include eight drugs-bupivacaine, fentanyl, ropivacaine, acetaminophen, tramadol, remifentanil, and dexamethasone-and five techniques-patient-controlled analgesia, epidural opioids, ultrasound-guided nerve blocks, continuous nerve blocks, and transversus abdominis plane block (presented according to their decreasing PI value in each category). RESULTS: Four of these drugs or techniques with the highest PI in 2011-2015 also held top positions even 20 years earlier: in 1991-1995, the PI for bupivacaine was 9.1; fentanyl, 6.6; patient-controlled analgesia, 10.4; and epidural opioids, 6.8. Since that time, their PI values slowly decreased, for the first three items by approximately 50% and much more than that (85%) with epidural opioids. Nevertheless, to this day, they continue to hold the highest degree of publication-based academic interest. The TJSI can be regarded as an index of expectations at the time of articles publication. With bupivacaine, fentanyl, patient-controlled analgesia, and epidural opioids, the TJSI exceeded the specific high threshold of 10.0 for a very long time. The TJSIs of acetaminophen, ketamine, and dexamethasone were increased with the advent of new expectations regarding the treatment of postoperative pain using these old agents. CONCLUSIONS: Two important developments related to ultrasound-guided nerve block and continuous nerve block demonstrated only a moderate degree of academic interest. In conclusion, even today, the greatest publication-based academic interest related to postoperative pain is associated with drugs and techniques introduced 40-50 years ago.

[Chemotherapy: from bacteria killer to antitumor agent : A striking transformation in the term over the last century]. / Chemotherapie: vom Bakterienkiller zum Tumortherapeutikum : Ein entscheidender Begriffswandel in den letzten hundert Jahren.

The term chemotherapy is more than 100 years old and during this period it has been going through decisive changes in terminology. Initially describing an antibacterial therapy it now is known as a part of the new oncologic therapy. Those upheavels and their causes are represented. Conclusively, the evolution of the urooncologic chemotherapy is briefly outlined.

[The worlds of gods in medicine]. / Götterwelten in der Heilkunde.

BACKGROUND: A number of designations for diseases, medicines and human body structures derive from classical mythology. To date, these eponyms have not been systematically investigated. OBJECTIVES: This paper provides an overview of this fringe component of medical vocabulary, looks at the history of several terms and formulates hypotheses as to why such creative etymologies have come into being. MATERIALS AND METHODS: In addition to relevant texts on ancient mythology, a variety of medical textbooks from the early modern period were analyzed. RESULTS: Between the 16th and the 20th centuries some 30 figures from Greek and Roman literature made their way into the terminology of medical sciences. A few of these expressions can be encountered in clinical use (e. g., Caput Medusae, Proteus, Oedipus complex) and remain official anatomical (atlas, Achilles tendon) or pharmaceutical nomenclature (atropine, morphine). The choice of these designations has often been similarity of form or analogies in function. Classical eponyms have gained acceptance on account of their succinctness, conciseness and scholarly veneer. Finally, this vocabulary shares its origin with other relevant terminology. CONCLUSIONS: In clinical classes, mythological designations can serve as a point of departure for digressions into literary, art and medical history in order to provide an understanding of cultural traditions and enhance education.

Hostage to History: The Duration of Antimicrobial Treatment for Acute Streptococcal Pharyngitis.

Oral antimicrobial treatment of acute streptococcal pharyngitis commonly is given for 10 days. An investigation was conducted of journal publications and textbooks from the dawn of the antimicrobial era to the present in order to discover the basis for this settled practice. Current treatment duration for acute streptococcal pharyngitis was established half a century ago under conditions significantly different from those currently encountered by the average clinician. The 10-day treatment standard evolved without scientific justification. There have been no therapeutic trials that have validated the necessity for 10 days of oral antimicrobial treatment. Yet, despite the lack of a scientific foundation, the rarity of acute rheumatic fever in developed countries, the high failure rate for streptococcal eradication and evidence that short-course therapy with a nonpenicillin antimicrobial yields equivalent eradication rates, the 10-day rule persists because of long clinical usage and the inherent power of the number 10. Efforts to change this clinical benchmark will likely meet with resistance from practicing physicians.

The medical treatment of Maria, Dowager Empress of the Russian Empire: an analysis of her prescription book from 1807 and 1808.

This study analyzes the medicines that were used to treat the Dowager Russian Empress Maria, widow of Tsar Paul I, and describes the doctors who cared for her health in 1807 and 1808. The source for this research was the imperial court pharmacy prescription book 1807-1811. Hypotheses about the diseases and medical problems of the Empress and how treatment for her differed according to circumstances, particularly after the loss of her granddaughter Princess Elizabeth, have been made based on the prescriptions recorded in the book. The content of the prescriptions suggests that the Empress suffered from gastrointestinal tract disorders, skin and eye diseases, neuralgic pains and insomnia. Foreign physicians educated in European universities worked at the imperial court and implemented European medical traditions. They took high positions in the administration and the medical education system, and gradually spread their experience and modern knowledge to Tsarist Russian society.

[Mining analysis on composition and medication of menstruation prescriptions in Fu Qingzhu's Obstetrics and Gynecology].

In this paper, menstruation prescriptions were selected from "Fu Qingzhu's Obstetrics and Gynecology" and analyzed by using GRI algorithm, correlation analysis, hierarchical clustering method through SPSS, Clementine and traditional Chinese medicine (TCM) inheritance auxiliary systems, in order to screen out 15 menopathy prescriptions, which involve 45 traditional Chinese medicine herbs. In the study, blood-tonifying and qi-tonifying herbs were found to be frequent in the prescriptions. The most frequent single herb was white paeony root, accounting for 9.6% in the total number of prescriptions; The most frequent herb pairs were white paeony root-radix rehmanniae preparata and paeony root-angelica sinensis. Among Fu Shan's menopathy prescriptions, 61 herbal pairs showed a correlation coefficient exceeding 0.05, which evolved into 16 pairs of core combinations. The analysis showed that menopathy prescriptions in volume 1 of "Fu Qingzhu's Obstetrics and Gynecology" focused on tonic traditional Chinese medicines involving liver, spleen and kidney and were adjusted according to changes in qi, blood, cold, hot and wet, which could provide a specific reference for further studies on Fu Shan's academic thoughts and traditional Chinese medicine clinical treatment of menopathy.

[Study on incompatibility of traditional Chinese medicines].

The incompatibility of traditional Chinese medicines is related to the clinical medication safety, so has attracted wide attentions from the public. With the deepening of studies on the incompatibility of traditional Chinese medicines represented by 18 incompatible herbs, the incompatibility of theory traditional Chinese medicines has raised to new heights. From the origin of incompatibility theory of traditional Chinese medicines, relationship of herbs, harms of incompatible herbs and principle of prevention to toxic effects of specific incompatible medicines, the innovation and development of the traditional Chinese medicine incompatibility theory was explored. Structurally, the incompatibility of traditional Chinese medicines refers to the opposition of two herbs based on seven emotions and clinical experience. The combination of incompatible herbs may lead to human harms, especially latent harm and inefficacy of intervention medicines. The avoidance of the combination of incompatible herbs and the consideration of both symptoms and drug efficacy are the basic method to prevent adverse reactions. The recent studies have revealed five characteristics of incompatible herbs. Toxicity potentiation, toxication, efficacy reduction and inefficacy are the four manifestations of the incompatible relations. The material changes can reflect the effects of toxicity potentiation and toxication of opposite herbs. The accumulation of toxicity and metabolic changes are the basis for latent harms. The antagonistic effect of main efficacies and the coexistence of positive and negative effects are the distinctive part of the incompatibility. The connotation of incompatible herbs plays an important role in the innovation of the traditional Chinese medicine incompatibility theory.

The evil of the unknown--risk-benefit evaluation of new synthetic drugs in the 19th century.

In the 19th century, synthetic chemistry discovered completely new chemical entities for medicinal use, which dramatically enriched the therapeutic armamentarium. However, no information was available regarding the safety of these new drugs, which were unrelated to most of the medicinal agents formerly known. Therefore, the question arises, if and how far, considerations regarding the relationship between benefit and risks were made. In this study, chloroform, phenazone (antipyrine) and sulfonal, were investigated as examples for drugs newly introduced in the 19th century. The results revealed that these drugs were provided by the manufacturer, tested by the physicians in a multicentre pattern and side effects were published in the medical literature soon after. Within a few years, several hundred cases were reported but the data were rarely summarized statistically. Therefore, physicians needed to stay updated with the medical literature because neither systematic industrial research nor regulatory authorities existed. The number of case reports within the first years were sufficient to detect common (> 1/100 to < 1/10) side effects but rare events were also reported. An extraordinary example is the drug-induced toxic epidermal necrolysis, which is commonly known as the Lyell syndrome or its less severe form, the Stevens-Johnson syndrome. This reaction has been clearly described by Baruch Spitz (1854-1932) as a side effect of antipyrine in 1887, several decades before Stevens, Johnson and particularly Lyell.

Bromine, bear-claw scratch fasciotomies, and the Eagle effect: management of group A streptococcal necrotising fasciitis and its association with trauma.

Necrotising fasciitis is a rare, but potentially fatal, soft-tissue infection. Historical depictions of the disease have been described since classical times and were mainly recorded in wartime reports of battle injuries. Although several different species of bacteria can cause necrotising fasciitis, perhaps the most widely known is group A streptococcus (GAS). Infection control, early surgical debridement, and antibiotic therapy are now the central tenets of the clinical management of necrotising fasciitis; these treatment approaches all originate from those used in wars in the past 150 years. We review reports from the 19th century, early 20th century, and mid-20th century onwards to show how the management of necrotising fasciitis has progressed in parallel with prevailing scientific thought and medical practice. Historically, necrotising fasciitis has often, but not exclusively, been associated with penetrating trauma. However, along with a worldwide increase in invasive GAS disease, recent reports have cited cases of necrotising fasciitis following non-combat-related injuries or in the absence of antecedent events. We also investigate the specific association between GAS necrotising fasciitis and trauma. In the 21st century, molecular biology has improved our understanding of GAS pathogenesis, but has not yet affected attributable mortality.

[Venom as a cure--some notes on ancient medicine]. / Tiergifte als Heilmittel--ein Beitrag zur Geschichte der antiken Medizin.

Very little is known today about the linguistics and facts relating to venoms in the ancient world. The article concerns itself initially with the terminology: How were venoms conceptualized and what position did they occupy among medicines and other poisons? Additionally ancient knowledge of the constitution and location of the venoms will be examined. Furthermore, it shall be outlined how it was perceived that the poisons actually took effect. The results of our investigations indicate that it was unlikely that venoms were used for medicinal purposes in ancient times.

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Clinical research before informed consent.

Clinical research with patient-subjects was routinely conducted without informed consent for research participation prior to 1966. The aim of this article is to illuminate the moral climate of clinical research at this time, with particular attention to placebo-controlled trials in which patient-subjects often were not informed that they were participating in research or that they might receive a placebo intervention rather than standard medical treatment or an experimental treatment for their condition. An especially valuable window into the thinking of clinical investigators about their relationship with patient-subjects in the era before informed consent is afforded by reflection on two articles published by psychiatric researchers in 1966 and 1967, at the point of transition between clinical research conducted under the guise of medical care and clinical research based on consent following an invitation to participate and disclosure of material information about the study. Historical inquiry relating to the practice of clinical research without informed consent helps to put into perspective the moral progress associated with soliciting consent following disclosure of pertinent information; it also helps to shed light on an important issue in contemporary research ethics: the conditions under which it is ethical to conduct clinical research without informed consent.

"Take your pill": the role and fantasy of pills in modern medicine.

The pharmaceutical industry has undergone a vast expansion in the 20th and 21st centuries. This article explores the central role now played by pills in clinical practice, but also in the public imagination. First, this article analyzes four properties that, together, account for many of the promises and perils associated with pills: They are ingestible, potent, reproducible, and miniaturized. This allows them to serve as ideal consumer items for widespread distribution and sale and also as model technological "devices" capable of downloading into the body healing chemicals. As such, they seem to promise a disburdening solution to many of life's ills. In our cultural fantasy, often shared by physician and patient alike, pills can be used not only to treat and prevent disease but also raise energy, lose weight, lessen pain, lift mood, cope with stress, and enhance sexual and athletic performance. This article also explores many adverse effects not only of pills themselves but of this exaggerated cultural fantasy of the pill. It tends to distract us from other, more holistic understandings of the locus of disease and healing. It even fosters misunderstandings of the ways in which pills themselves work, which is to assist bodily processes, and the mind's "meaning response." The intent here is not to demonize all pills-many have great therapeutic potential-but to learn how to better choose and use them wisely. We propose that this process be assisted through recontextualizing the pill as a multidimensional gift. Taken in such a way, with appropriate gratitude and discernment, we may ingest fewer pills, but with greater efficacy.