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Archive for the category “basic medical sciences1”

Pharmacorhythmics

The study of drugs as for their chemical nature and therapeutic applications is included in the subject ‘pharmacology’. In typical medical courses the drugs are presented in relation to the body system for which they are usually used; e.g. drugs of digestive system, drugs of the eye and so on. In such way many students do not like the subject as it would overstrain their memorization capacity. In another apparently not better working style the drugs are ordered in alphabetical manner regardless their uses or forms. If this would be the case, medical teachers and students should find some compromise in learning pharmacology with more appreciation for its importance for the medical practitioner.

Indeed, in pharmacology we find interesting information about drugs as regard their metabolism in the body (pharmacokinetics), effect (pharmacodynamics) and relation to genetic factors (pharmacogenomics). In the latter theme the individual response to some drug is handled so that the drug type, form and dose would be appropriately tailored to suit a given type of patient. This would rely on the fact that there could be differences among different persons in their tolerance and response to some drug depending on differences in metabolic machinery (e.g. enzymes) which in turn have to do with the genetic makeup. Given the sophistication and high expenditure of those tests for individualized drug tailoring their applications would considerably differ by time and place. However, the keen appreciation of such differences can prove crucial for wise and prudent use of medically important drugs.

In this topic I may point to an interesting aspect of studying drugs concerning the frequency or mode of its taking. For examples: how often a dose should be given? Should it follow some diurnal rhythm (morning, day or night)? should the dose be always the same in some application context? How should be then its pattern in case it might be changing? ‘Pharmacorhythmics’ would consider an individualized drug dose, pattern and frequency to best suit a given patient in a given medical context. Needless to emphasize that such drug “iterations” need good knowledge of drugs and their particular therapeutic contexts.

Euphemera

euphemera
To coin a term or find a name of some meaning whether abstract or sensual could be the basic challenge that people face. From this point of view a good feeling and passion to language appears to be a prerequisite for a significant scientist.

In this essay I would like to throw light on a concept or a phenomenon regarding the action of drugs which I, at least for this time, would call ‘euphemera’. A typical medicine would be studied to know its properties which include physical, chemical, pharmacologic and clinical aspects. Euphemera (opposite would be also dysphemera) would like to imply the very initial feeling (effect) of the drug after its application or ingestion even before it is quite and fully distributed in the body partitions or compartments, even before it is well mixed in the stomach juice. In other words, whether the drug would have a nice and beneficial effect could/should be evident from the very beginning of taking it rather than after a while when it’s equilibrated in all body fluids. This concept or impression may denote a sort of illusion or a phenomenon that may not be amenable to study. Or, however, it may provide an interphase between science and predetermination (natural setup). Indeed, the medicinal substances my otherwise exert their effect very rapidly especially when they are taken in situations when they are most needed and, thence most effective (inundation moment).

In studying such a phenomenon of euphemera we may find out different versions like true euphemera and false euphemera. This may be of help to tell about, so that the person would be reassured about the very initial feelings when taking a medicine.

Euphemera (eu: good; ephemeral: lasting short)

Human physiology – a continuum of balance

Human physiology – a continuum of balance

Physiology is the science concerned with the body functions and its underlying mechanisms. It is one of the basic medical sciences including anatomy, histology, pathology, microbiology and pharmacology. The advantage that physiology could have compared to other basic sciences is that it goes hand in hand with body function, regulation and disturbance. Anyhow, it could be agreed upon that separation of basic sciences may apply only for simplification and study purposes rather than for real and working performances.

Sticking to basics and practical problems it may be quite obvious that medical staff including physicians study physiology in order to care of sick individuals especially those in serious conditions that need timely and efficient management. In this respect the appreciation and mastering of basic body functions that normally work dependent on each other like and for a continuum balance would make the difference in defining certain outcome. That is why studying physiology as a basic medical study course should be precise, focused and appropriately modular. In other words, the objective view and appreciation of the dynamic and interconnected body functions in a working and easily perceived biophysical model could be that what is conceived in memory and helps in health problem solving apart from many apparently irrelevant and superfluous details.

A well known medical term is homeostasis which would mean the fundamental criterion of keeping the body internal environment within a normal range of biochemical and biophysical values in a dynamic steady state. Therefore, homeostasis concludes the ultimate goal of all physiological processes and describes biological and living systems as comprehensively and elegantly as possible. Behind the coulisses of homeostasis one might see several body organs and tissues, each assigned to a certain function, that work dependently in harmony. Again, one may prefer to reduce those functions to their underlying biochemical and biophysical component forces that could be approximated to a couple of laws or mathematical equations. Such preference could be based on both personal views and study or experimental facilities and should accordingly influence medical case management in terms of time, technical issues, costs and ultimately outcome.

As it could be understood from the discussion above, studying physiology outside its pathophysiological frame would be a matter of time waste. This is simply because investigating disease is an essential drive and clue as well to understand a certain normal physiological process (recall the purpose of physiology as basic medical course mentioned earlier in the essay). Accordingly, it may be very rational to establish a general check list or scheme when discussing a given physiological or pathophysiologic question. Such a check list can include body temperature, pulse, blood pressure, pH, electrolytes, general condition, mood, and any emergent complaint. To conclude this essay on human physiology, it signifies the importance of modular systematic physiology and systematic review of its findings and examination.

Must know facts in medicine

Are there any facts in medicine? This question may come to medical students because of the many situations where a certain finding or outcome cannot be stated clearly or absolutely and not to forget the usual gap between academic study and the real daily practice. In this essay I would like to try to give a reasonable answer to this question if there could be any solid basis (evidence-based facts) for medical practice.
On one extreme of the scale, the human body should be regarded as a mere machine, a living machine, only in order to objectify and modularize the medical facts that we are looking for.
I. Generalities:
1- Doctor’s collegial conduct.
2- A well defined and openly made medical service fee (physician and other costs) is the only most effective statement to guarantee a responsible conduct of service giver and taker.
3- A substantial number of people’s morbidity or death is caused directly by medical staff dehiscence and faults.
4- Human body function and health is amenable to study and predict by mathematical methods such as probability estimation.
5- Patient’s misery for doctor but doctor’s ‘revelation’ for patient.
II. Functionalities:
1- Spatiotemporal connection.
2- No price for an absent goat. No single organ can replace or cover the absence of another organ.
3- Once born is done. The new born is completely made person that will change almost only in shape and size (genetic and social constitution).
4- Consolidation rule.
5- Life is neither gifted nor robbed.
III. System operation:
1- A human is an open system organo-heterotroph.
2- Self and nonself (immune system).
3- Flow and stagnation (in- and outflow).
4- True- and malposition (body positioning).
5- Juvenility and aging.
IV. Pathognomonic criteria:
1- Vital data (temperature, blood pressure, heart rate).
2- Inspection and light transmission.
3- Palpation, percussion and auscultation.
4- Reflex arches.
5- Biochemical and radiologic tests.
V. Remedies:
1- Social manipulation.
2- Life style.
3- Antibiotics.
4- Medical remedies.
5- Anesthesia and surgery.

The clapper and the intonation room, a hypothetical medical context

the clapper and the intonation room
In medicine it is usually reasonable to consider the clapper (the heart) together with its intonation room (the lungs). The cardiorespiratory cycle may, therefore, be considered one entity and should be split only for simplicity. The academic question in this point is how the two phases of respiration are orchestrated with the two phases of cardiac cycle, from one side, and with the concurrent gas/metabolite exchanges in the lungs and tissues, from the other side. Although I did not yet look for an authenticated answer, I would like to present in this text a hypothetical model based on common sense and the concept of lung compliance.

The clapper has got in intrinsic rhythmicity and alternates between contraction (systole) and relaxation (diastole). Although the serial 4- station pass of blood (the cardiac cycle) would be very exciting, i.e. right atrium > right ventricle > left atrium (through the lungs) > left ventricle (to systemic circulation), and might be apparently conforming with the site of SAN and AVN and the path of nerve impulse conduction, a 2- station pass may be described in text books, in which model the right and left hearts are switched in parallel. Yet, to fulfill my scientific fantasy, even a minor right to left lag might be present.

As the right ventricle contracts blood goes to the lungs (through the pulmonary arteries), and the lungs increase minimally in volume due to elastic recoil of the pulmonary arteries. Meanwhile, the volume of the lungs may be increased by inspiration. Such an increase in lung volume by inspiration is not factually essential for right ventricular contraction to happen with more ease because normally lung resistance is quite small to accommodate an average right ventricular systole. The presumption here is that right ventricular systole is orchestrated with an inspiration, i.e. the inspiration may be almost synchronous with the systole but not necessary equal in length. Because of the phenomenon of lung hysteresis, I may guess that expiration is more concerned with gas exchange in the lungs than inspiration may be (the model may be instantaneous more than sloping in this regard) and this would suggest that right ventricular diastole, when no more blood is ejected into the lungs, is almost synchronized with expiration as air is exhaled out; right ventricular systole/ lung inspiration > right ventricular diastole/ lung expiration, and this would be my hypothesized cardiorespiratory cycle (1).

The same idea may be applied on the left heart: left ventricular systole/ arterial recoil and capillary refilling > left ventricular diastole/ capillary resilience, when almost gas and metabolite exchange takes place between blood and tissues, i.e. again a more instantaneous than sloping model is suggested (2). The movement of fluid in the vicinity of the capillaries would follow a rather sloping model where a fluid outflow gradient on the arterial side of the capillary may be appropriately counterbalanced by another fluid inflow gradient on the venous side.

I may be eligible to confer this package of cardipulmonary assumptions the term: Gharabawy’s cardiorespiratory axioms. Though the right blood circulation may seem shorter than the left one, the total paths of deoxygenated and oxygenated blood seem to be equal. The two assumptions noted above as (1) and (2) can be represented as follows:
the clapper and the intonation room 2 (2)

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