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Tresker S. An account of medical treatment, with a preliminary account of medical conditions. Theor Med Bioeth 2023; 44:607-633. [PMID: 37620606 DOI: 10.1007/s11017-023-09641-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/26/2023]
Abstract
In this article, I present a philosophical account of medical treatment. In support of this account, I offer a suggestive account of medical conditions. The account of medical treatment uses three desiderata to demarcate treatment from non-treatment. Namely, a treatment should: (1) be describable by features that enable it to be standardized and characterized as a discrete intervention, (2) target a specific medical condition, and (3) have the possibility of being effective. The account of medical conditions underlies the second desideratum and attempts to tie medical conditions closely to biological dysfunction, while also including some conditions for which biological dysfunction is absent or its presence uncertain. I offer a simple typology of treatments and show how the accounts are relevant to treatment effectiveness, disease, placebos, contested treatments, and treatment standardization.
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Affiliation(s)
- Steven Tresker
- Department of Philosophy, University of Antwerp, Rodestraat 14, Antwerp, 2000, Belgium.
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Kovács L, Eszter Horváth D, Virágh É, Kálmán B, Dávid ÁZ, Lakatos P, Lőcsei Z, Toldy E. Analytical, experimental and clinical aspects of total 25-hydroxyvitamin D measurement by two ligand assays are differentially biased by disease-related factors. Steroids 2022; 180:108968. [PMID: 35122787 DOI: 10.1016/j.steroids.2022.108968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 12/21/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pathological concentrations of plasma proteins may confound the results of binding assays. We compared two routinely used total 25-hydroxyvitamin D [t-25(OH)D] methods: a chemiluminescence-immuno-(CLIA) and an electro-chemiluminescence-protein-binding-(ECLPBA) assay. METHODS Two sub-studies were performed: 1) In an "in vitro" study, exogenous albumin was added to pools of patients' sera with low albumin levels; and 2) In "ex vivo" studies of Cohort_1: sera of hospitalized patients with low albumin levels, and of healthy controls; and of Cohort_2: outpatients with chronic kidney disease in pre-dialysis stage, or on peritoneal dialysis and hemodialysis were investigated by the routine and LC_MS/MS methods. RESULTS When increasing albumin concentrations were "in vitro" added, t-25(OH)D levels were overestimated by ECLPBA, and underestimated by CLIA. In patients' sera, positive correlations were detected between t-25(OH)D-vitamin D binding protein (DBP) values by both routine methods, and between t-25(OH)D-albumin values by all three methods. Much higher t-25(OH)D was measured by LC_MS/MS in all subgroups. When altering albumin levels with constant DBP concentration, the "in vitro" experiment revealed a higher sensitivity of ECLPBA. The "ex vivo" measurements demonstrated clinically relevant differences between the routine methods. CONCLUSION Both routine methods are dependent of the matrix effect in hospitalized patients, which is predicted by the DBP/Albumin ratios. In hemodialysis, ECLPBA is recommended because its outcomes differ less from those of LC_MS/MS. The results of LC_MS/MS are reliable, but not routinely available. A guidance would be valuable on how levels measured by the binding methods differ from those by LC-MS/MS in various clinical conditions.
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Affiliation(s)
- László Kovács
- Department of General Internal Medicine, Markusovszky University Teaching Hospital, 5 Markusovszky Street, Szombathely 9700, Hungary; B. Braun Avitum Hungary Ltd Dialysis Center N(o) 6, Szombathely, Hungary, 1-3 Hübner János Street, Szombathely 9700, Hungary
| | - Dóra Eszter Horváth
- Department of General Internal Medicine, Markusovszky University Teaching Hospital, 5 Markusovszky Street, Szombathely 9700, Hungary
| | - Éva Virágh
- Department of General Internal Medicine, Markusovszky University Teaching Hospital, 5 Markusovszky Street, Szombathely 9700, Hungary
| | - Bernadette Kálmán
- Department of Laboratory Medicine, School of Medicine, University of Pecs, 13 Ifjúság Street, Pécs 7624, Hungary
| | - Ádám Z Dávid
- Egis Pharmaceuticals PLC, 30-38 Keresztúri Street, Budapest 1106, Hungary
| | - Péter Lakatos
- Department of Internal Medicine and Oncology, Semmelweis University, School of Medicine, 2/a Korányi Sándor Street, Budapest 1083, Hungary
| | - Zoltán Lőcsei
- Department of General Internal Medicine, Markusovszky University Teaching Hospital, 5 Markusovszky Street, Szombathely 9700, Hungary
| | - Erzsébet Toldy
- Clinical Chemistry and Immunology Laboratories, SYNLAB Diagnostic Centre, 5-7 Weiss Manfréd Street, Budapest 1211, Hungary; Institute of Diagnostics, School of Health Science, University of Pécs, 4 Vörösmarty Street, Pécs 7621, Hungary.
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Fernandes CM, Dias SL, Ferreira MC, Luna EJA. COVID-19 post-vaccination in healthcare workers and vaccine effectiveness, Brazil, 2021. Clinics (Sao Paulo) 2022; 77:100109. [PMID: 36179526 PMCID: PMC9464573 DOI: 10.1016/j.clinsp.2022.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/28/2022] [Accepted: 08/29/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTS This study aimed to describe COVID-19 cases in healthcare workers at a large tertiary hospital, after a vaccination campaign, to understand the individual characteristics, timeliness, symptomatology, and severity of the conditions. METHODS The COVID-19 reporting files from the hospital's healthcare workers and their records in the vaccine registry were analyzed, regarding vaccination status, symptoms, sociodemographic characteristics, comorbidities, and outcomes. Vaccination descriptive analysis was carried out and the impact and effectiveness of vaccination in relation to symptomatic infection and hospitalization were estimated. RESULTS In a total of 696 PCR-confirmed COVID-19 patients, vaccination coverage for the 1st and 2nd dose was 92.8% and 85.5%. Patients with complete doses had a mean interval of 96.8 days between vaccination and the onset of symptoms. Of the 664 participants with available clinical data, 165 had at least 1 comorbidity. During the study, 12 patients were hospitalized, 58.3% with a complete vaccination schedule. Three of this group died. The effectiveness of vaccination for symptomatic cases and hospitalization was 22.1% and 69.0%, respectively. The impact of vaccination on symptomatic cases and hospitalization was 81.4% and 89.7%, respectively. DISCUSSION The majority of COVID-19 cases in the study were classified as mild. The impact of vaccination for confirmed cases was significant, both in reducing the incidence of symptomatic cases and hospitalizations. The presence of comorbidities in approximately ¼ of the patients increased the risk of these individuals. The mean time interval between diagnosis and the 2nd dose of vaccine was longer in the hospitalized group, reinforcing the protective decline over longer periods.
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Affiliation(s)
- Caio Medeiros Fernandes
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
| | - Shirley L Dias
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Maira C Ferreira
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Expedito J A Luna
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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Mehta Y, Mehta C, Kumar A, George JV, Gupta A, Nanda S, Kochhar G, Raizada A. Experience with hemoadsorption (CytoSorb ®) in the management of septic shock patients. World J Crit Care Med 2020; 9:1-12. [PMID: 32104647 PMCID: PMC7031623 DOI: 10.5492/wjccm.v9.i1.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/23/2019] [Accepted: 01/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cytokines and inflammatory mediators are the hallmarks of sepsis. Extracorporeal cytokine hemoadsorption devices are the newer clinical support system to overcome the cytokine storm during sepsis.
AIM To retrospectively evaluate the clinical outcomes of patients admitted in intensive care unit with septic shock with different etiologies.
METHODS The laboratory parameters including biomarkers such as procalcitonin, serum lactate and C-reactive protein; and the hemodynamic parameters; mean arterial pressure, vasopressor doses, sepsis scores, cytokine levels and other vital parameters were evaluated. We evaluated these outcomes among survivors and non-survivors.
RESULTS Of 100 patients evaluated, 40 patients survived. Post treatment, the vasopressors dosage remarkably decreased though it was not statistically different; 34.15% (P = 0.0816) for epinephrine, 20.5 % for norepinephrine (P = 0.3099) and 51% (P = 0.0678) for vasopressin. In the survivor group, a remarkable reduction of biomarkers levels; procalcitonin (65%, P = 0.5859), C-reactive protein (27%, P = 0.659), serum lactate (27%, P = 0.0159) and bilirubin (43.11%; P = 0.0565) were observed from baseline after CytoSorb® therapy. A significant reduction in inflammatory markers; interleukin 6 and interleukin 10; (87% and 92%, P < 0.0001) and in tumour necrosis factor (24%, P = 0.0003) was also seen. Overall, 28 (28%) patients who were given CytoSorb® therapy less than 48 h after onset of septic shock survived and the maximum duration of stay for 70% of these patients in intensive care unit was less than 15 d.
CONCLUSION CytoSorb® is a safe and well tolerated rescue therapy option in patients with septic shock. However, early (preferably within < 48 h after onset of septic shock) initiation could result in better clinical outcomes. Further randomized trials are needed to define the potential benefits of this new treatment modality.
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Affiliation(s)
- Yatin Mehta
- Medanta The Medicity, Gurgaon 122001, Haryana, India
| | - Chitra Mehta
- Medanta The Medicity, Gurgaon 122001, Haryana, India
| | - Ashish Kumar
- Medanta The Medicity, Gurgaon 122001, Haryana, India
| | | | - Aditi Gupta
- Medanta The Medicity, Gurgaon 122001, Haryana, India
| | - Saurabh Nanda
- Medanta The Medicity, Gurgaon 122001, Haryana, India
| | | | - Arun Raizada
- Medanta The Medicity, Gurgaon 122001, Haryana, India
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Tistarelli N, Fagnani C, Troianiello M, Stazi MA, Adriani W. The nature and nurture of ADHD and its comorbidities: A narrative review on twin studies. Neurosci Biobehav Rev 2019; 109:63-77. [PMID: 31838192 DOI: 10.1016/j.neubiorev.2019.12.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/06/2019] [Accepted: 12/11/2019] [Indexed: 12/26/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children worldwide, and also the recognition of its persistence into adulthood is increasing. While ADHD in childhood is highly heritable and mostly driven by familial factors, during adulthood it appears to show a lower heritability, even if there is not total agreement on this yet. This disorder often co-occurs with many other conditions, which also vary across the different stages of development, and several studies have used the twin design to investigate these comorbidities, giving valuable insights into the origins of the observed co-occurrence. This review aims to summarize the main results of twin research, according to the following domains: individual traits, cognitive impairment, behavioral manifestations, clinical conditions and psychosocial risk factors. Individual features seem to play a role in this symptomatology and include personality traits such as negative emotionality, personality disorders and temperamental dimensions with a predominance of novelty seeking. At a lower level, ADHD is associated with both functional and anatomic brain characteristics. ADHD is also associated with some forms of cognitive impairment, such as sluggish cognitive tempo, and learning disabilities, with a specific predisposition to reading disability. In addition, ADHD is strongly associated with externalizing disorders such as conduct disorder and oppositional defiant disorder, and some behavioral outcomes, particularly substance use and abuse both in adolescence and adulthood. Moreover, ADHD symptoms often overlap with other psychological disorders, namely affective and internalizing disorders, as well as autism spectrum disorder and autistic-like traits in a wider sense. Notably, a genetic overlap has been found between asthma and ADHD, particularly with respect to hyperactivity/impulsivity dimensions. ADHD also appears to represent a risk factor for disordered eating, and, more specifically, for binge eating and bulimia nervosa. Finally, among psychosocial factors, an association has been proposed between childhood maltreatment and ADHD symptoms.
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Affiliation(s)
- Naomi Tistarelli
- Department of Brain & Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Corrado Fagnani
- Center "Behavioral Sciences and Mental Health", Istituto Superiore di Sanità, Rome, Italy
| | | | - Maria Antonietta Stazi
- Center "Behavioral Sciences and Mental Health", Istituto Superiore di Sanità, Rome, Italy
| | - Walter Adriani
- Center "Behavioral Sciences and Mental Health", Istituto Superiore di Sanità, Rome, Italy.
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Abstract
Muscle atrophy typically is a direct effect of protein degradation induced by a diversity of pathophysiologic states such as disuse, immobilization, denervation, aging, sepsis, cachexia, glucocorticoid treatment, hereditary muscular disorders, cancer, diabetes and obesity, kidney and heart failure, and others. Muscle atrophy is defined by changes in the muscles, consisting in shrinkage of myofibers, changes in the types of fiber and myosin isoforms, and a net loss of cytoplasm, organelles and overall a protein loss. Although in the literature there are extensive studies in a range of animal models, the paucity of human data is a reality. This chapter is focused on various aspects of muscle wasting and describes the transitions of myofiber types during the progression of muscle atrophy in several pathological states. Clinical conditions associated with muscle atrophy have been grouped based on the fast-to-slow or slow-to-fast fiber-type shifts. We have also summarized the ultrastructural and histochemical features characteristic for muscle atrophy in clinical and experimental models for aging, cancer, diabetes and obesity, and heart failure and arrhythmia.
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Affiliation(s)
- Adrian Dumitru
- Department of Pathology, Emergency University Hospital, Bucharest, Romania
| | - Beatrice Mihaela Radu
- Faculty of Biology, Department of Anatomy, Animal Physiology and Biophysics, University of Bucharest, Bucharest, Romania.,Life, Environmental and Earth Sciences Division, Research Institute of the University of Bucharest (ICUB), Bucharest, Romania
| | - Mihai Radu
- Department of Life & Environmental Physics, 'Horia Hulubei' National Institute for Physics & Nuclear Engineering, Magurele, Romania
| | - Sanda Maria Cretoiu
- Division of Cell and Molecular Biology and Histology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
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Sansone CM, Prendin F, Giordano G, Casati P, Destrebecq A, Terzoni S. Relationship between Capillary Refill Time at Triage and Abnormal Clinical Condition: A Prospective Study. Open Nurs J 2017; 11:84-90. [PMID: 28839512 PMCID: PMC5543682 DOI: 10.2174/1874434601711010084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/05/2017] [Accepted: 05/23/2017] [Indexed: 12/29/2022] Open
Abstract
Background: Capillary refill time has been studied in literature as a perfusion indicator. Two pilot studies have proposed possible reference values in healthy adults. No data exist regarding capillary refill time as an indicator of abnormal clinical conditions in adults, which might be of help for triage nurses. Objective: We wanted to assess if any relationships existed, between altered capillary refill time and abnormal clinical conditions in the emergency department. We investigated relations between capillary refill time and vital signs recorded in triage and blood tests, by analyzing the clinical records. Mortality at 24 hours, 7 days and over 14 days was investigated by calling the patients after discharge. Method: Observational, single-center study on a sample of consecutive patients aged ≥ 18 years in the Emergency Department of a major Milan hospital, from June to October 2014. Multivariate logistic regression was used to investigate the impact of clinical variables on capillary refill time. Results: 1001 patients were enrolled, aged 59 ± 21 (473 aged 65 or more). Longer refill times were found in patients admitted to hospital units after medical consultations in the emergency department compared to those discharged or sent to outpatients. In elderly patients, statistically significant association was found between increased capillary refill time and sepsis (sensitivity 100%, specificity 83.33%, area under the receiver operating characteristics curve 65.95% CI 47-83), oxygen saturation, mean blood pressure, and lactates. In persons aged 45 to 64, altered refill times were associated with abnormal values of glicemia, platelets, and urea. Conclusion: Capillary refill time can be used by nurses at triage as a complementary parameter to normal vital signs. This is one of the few studies investigating refill time in adult patients.
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Affiliation(s)
- Claudia M Sansone
- Nurse, Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Corso Mazzini 18, 28100 Novara, Italy
| | - Fabiano Prendin
- Nurse, Emergency Department, San Paolo teaching hospital, Via A. di Rudinì, 8 - 20142 Milan, Italy
| | - Greta Giordano
- Nurse, ASST Santi Paolo e Carlo, presidio San Paolo, Via A. di Rudinì, 8 - 20142 Milan, Italy
| | - Paola Casati
- Operating theatre, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Anne Destrebecq
- Associate professor of Nursing, University of Milan, Via Ovada, 26 - 20142 Milan, Italy
| | - Stefano Terzoni
- PhD, Tutor Nurse, San Paolo bachelor school of Nursing, San Paolo teaching hospital, Via Ovada, 26 - 20142 Milan, Italy
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Cranston M, Semple C, Duckitt R, Vardi M, Lindgren S, Davidson C, Palsson R. The practice of internal medicine in Europe: organisation, clinical conditions and procedures. Eur J Intern Med 2013; 24:627-32. [PMID: 24028929 DOI: 10.1016/j.ejim.2013.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/29/2013] [Accepted: 08/06/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Current information on the role of internists in the European countries is scarce. This report describes the results of a survey of the practice of internists in Europe. METHODS Two online questionnaire-based surveys were carried out by the European Board of Internal Medicine, one on the practice of internists and the other on postgraduate training in internal medicine. The national internal medicine societies of all 30 member countries of the European Federation of Internal Medicine were invited to participate. The responses were reviewed by internal medicine trainees from the respective countries and summaries of the data were sent to the national societies for approval. Descriptive analysis of the data on the practice of internists was carried out. RESULTS Twenty-seven countries (90%) completed the questionnaire and approved their datasets. In 8 European countries, most internists practised internal medicine alone and in 7 countries at least half of physicians practised internal medicine together with a subspecialty. Internal medicine was considered a hospital-based specialty in most countries. The majority of selected presenting problems and diagnoses were rated as commonly encountered in all countries. More variability between countries was observed in the performance of diagnostic and therapeutic procedures. CONCLUSION Many similarities exist in the practice of internal medicine between the European countries, while some differences are present that likely reflect the variable impact of subspecialisation. The results of the survey should prove valuable for the definition of specific competencies and development of a common curriculum for internal medicine at the European level.
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Affiliation(s)
- Mark Cranston
- West Suffolk Hospital, Bury St Edmunds, United Kingdom
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