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British Journal of Cancer Aug 2023Studies to date have yielded inconclusive results as to whether maternal medical history during pregnancy, and a child's early-life medical history contribute to the...
BACKGROUND
Studies to date have yielded inconclusive results as to whether maternal medical history during pregnancy, and a child's early-life medical history contribute to the development of childhood brain tumours (CBTs). This study examined associations between maternal and childhood medical history and the risk of CBTs.
METHODS
The Childhood Brain Tumour Epidemiology Study of Ontario (CBREO) examined children 0-15 years of age with newly diagnosed CBTs from 1997 to 2003. Multivariable logistic regression analysis determined associations for prenatal medications and childhood medical history, adjusted for child's demographics, and maternal education. Analyses were stratified by histology. A latency period analysis was conducted using 12- and 24-month lead times.
RESULTS
Maternal intake of immunosuppressants during the prenatal period was significantly associated with glial tumours (OR 2.73, 95% CI 1.17-6.39). Childhood intake of anti-epileptics was significantly associated with CBTs overall, after accounting for 12-month (OR 8.51, 95% CI 3.35-21.63) and 24-month (OR 6.04, 95% CI 2.06-17.70) lead time before diagnosis. No associations for other medications were found.
CONCLUSIONS
This study underscores the need to examine potential carcinogenic effects of the medication classes highlighted and of the indication of medication use. Despite possible reverse causality, increased CBT surveillance for children with epilepsy might be warranted.
Topics: Child; Female; Pregnancy; Humans; Case-Control Studies; Ontario; Prenatal Exposure Delayed Effects; Family; Brain Neoplasms; Risk Factors
PubMed: 37165200
DOI: 10.1038/s41416-023-02281-3 -
Cureus Oct 2023Dysmenorrhea is a menstrual disorder characterized by painful uterine cramps that occur during menstruation. There are two types of dysmenorrhea, primary and secondary.... (Review)
Review
Dysmenorrhea is a menstrual disorder characterized by painful uterine cramps that occur during menstruation. There are two types of dysmenorrhea, primary and secondary. It affects 45-95% of all menstruating women worldwide. The prevalence in India is approximately 75%. Primary dysmenorrhea diagnosis is based on the patient's medical history and physical examination. If the history of start and duration of lower abdominal discomfort suggests secondary dysmenorrhoea or if the dysmenorrhoea does not respond to medical treatment, a pelvic examination is necessary to evaluate dysmenorrhoea. Because of the increasingly large number of women who are impacted by primary dysmenorrhea, it should be a public health concern that authorities must address. Abdominal stretching is a very simple, efficient, and risk-free workout. Some of the benefits of stretching exercises for dysmenorrhea include increased elasticity and strength of the spine and pelvic muscles and reduction in pain. The knee-to-chest exercise in combination with hydrocollator packs has a significant effect in improving the pain and the monthly irregularities in primary menstrual pain. Massage of connective tissue is a form of cutaneous stimulation that tries to stimulate the connective tissue's mechanical receptors. Connective tissue massage studies for treating a range of dysfunctions usually indicate that patients treated with this modality get pain alleviation and even complete remission.
PubMed: 37933353
DOI: 10.7759/cureus.46553 -
Medical History Jul 2023In contrast to the well-known stories of the embryotoxic drug, thalidomide, in countries where it was responsible for large numbers of birth defects, there is limited...
In contrast to the well-known stories of the embryotoxic drug, thalidomide, in countries where it was responsible for large numbers of birth defects, there is limited information on its history in India. Its presence before 2002, when the country issued the first marketing licence for a thalidomide-containing preparation, is assumed to be negligible. This article challenges this view by showing that the drug entered the Indian subcontinent through the former Portuguese territory of Goa around 1960. We examine the subsequent development of its distribution, use and regulation in India from the mid-1960s up to the present situation. Colonial legacies are a crucial explanation for the early appearance of thalidomide on the Indian subcontinent. They also influenced its re-emergence as drug for treating leprosy reactions in India after 1965. We identify key actors in this process: the original German producer that delivered thalidomide free of charge, European doctors who worked for international non-governmental organizations, the World Health Organization (WHO), which supported clinical trials and later discouraged the use of the drug, and finally the Indian state institutions that limited its distribution and later quickly opened the way for the private sector to produce and market thalidomide and its analogues. Finally, we discuss the risk of thalidomide-induced birth defects by casting a critical look on the present state of regulatory provisions and the monitoring of birth defects in India.
Topics: Humans; Thalidomide; India; Physicians; World Health Organization
PubMed: 37668377
DOI: 10.1017/mdh.2023.27 -
Cureus Sep 2023This article presents two individuals with different clinical presentations who experienced spontaneous pneumomediastinum following the chronic use of marijuana....
This article presents two individuals with different clinical presentations who experienced spontaneous pneumomediastinum following the chronic use of marijuana. Pneumomediastinum has been associated with marijuana use due to the prolonged inhalation and breath-holding mechanisms employed during consumption. The first case involves a 24-year-old woman with a history of anxiety and chronic marijuana use, who presented to the emergency department with atypical chest pain and shortness of breath. The second case involves a 21-year-old man with no previous medical history, who experienced acute chest pain after smoking marijuana. Both individuals exhibited signs of pneumomediastinum on imaging studies and were treated with oxygen therapy and analgesics. The cases emphasize the importance of considering pneumomediastinum in patients with atypical chest pain, particularly in chronic cannabis users.
PubMed: 37829949
DOI: 10.7759/cureus.45033 -
Lakartidningen Nov 2023Head trauma is a common reason for emergency department visits, majority of these are mild traumatic brain injuries (mTBI). Only a small proportion of mTBI patients...
Head trauma is a common reason for emergency department visits, majority of these are mild traumatic brain injuries (mTBI). Only a small proportion of mTBI patients develop an intracranial hemorrhage and even fewer require neurosurgical intervention. To determine which patients require a brain computed tomography (CT) scan (without contrast), which patients can be discharged and which require hospitalization for observation, several steps are required. These include a thorough assessment of medical history and clinical examination. By utilizing established guidelines and analyzing the gathered information, it is possible to identify the appropriate course of action for each patient. Further management is based on findings on the brain CT scan.
Topics: Humans; Retrospective Studies; Tomography, X-Ray Computed; Brain Concussion; Craniocerebral Trauma; Hospitalization; Glasgow Coma Scale
PubMed: 38018485
DOI: No ID Found -
Ui Sahak Aug 2023Currently, the education of the history of medicine in South Korea has established a solid foundation. Since Kim Du-jong (1896-1988) began giving medical history...
Currently, the education of the history of medicine in South Korea has established a solid foundation. Since Kim Du-jong (1896-1988) began giving medical history lectures at Severance Medical College in 1946, a total of 22 universities-over half of the 40 total universities-have implemented medical history education in the curriculum as of 2023. Furthermore, several textbooks and translations summarizing Western and Korean medical history have been published. However, despite this expansion, there has been little discussion on how to implement medical history education for students. To address this gap, this study examines the period and structure of medical history education, as well as various teaching methods, while considering their respective advantages and disadvantages. Firstly, there are two main approaches to implementing medical history education. One approach integrates medical history throughout the entire educational process, while the other concentrates on specific stages of education. Both approaches extend beyond undergraduate education and encompass medical education after graduation. The former emphasizes integration with basic medical and clinical education, while the latter focuses on ensuring educational coherence. Secondly, the structure of medical history courses can be broadly categorized as chronological or thematic. Within the chronological approach, there are two subcategories: general and periodic. The general method is traditionally used in history education but may be rigid in structure and fail to engage students' interest. On the other hand, the period method conveys multidimensional and comprehensive understanding of different periods but may make it challenging to grasp the overall flow of history, resulting in fragmentation of the course. Thematic structure can be further divided into topic-centered and field-specific methods. Both approaches allow for adjusting the content and arrangement of courses based on student interests and teaching conditions, but they present challenges in maintaining the coherence of the entire course. Lastly, the teaching methods in medical history education can be categorized into traditional lectures, small-group discussions, and individual research guidance. Most medical history courses adopt a lecture-based teaching method, which effectively provides diverse knowledge to medical students who may be unfamiliar with historical research and methodology. However, due to the one-directional nature of the instruction and the passive role of the learners, it can be challenging to stimulate learners' motivation or assess their understanding. Consequently, recent changes try to incorporate active learning through small-group discussions and individual research guidance.
Topics: History of Medicine; Humans; Schools, Medical; Medicine; Educational Status; Education, Medical; Students, Medical
PubMed: 37718563
DOI: 10.13081/kjmh.2023.32.595 -
Cureus Dec 2023We present the case of a 74-year-old woman, functionally independent in her daily activities, with a medical history notable for hypertension and dyslipidemia. She...
We present the case of a 74-year-old woman, functionally independent in her daily activities, with a medical history notable for hypertension and dyslipidemia. She presented to the emergency room with an altered level of consciousness, opening her eyes only to pain, no verbal response, and flexion withdrawal from pain coupled with a Glasgow Coma Scale of 7. The intensive care unit was promptly summoned, and the patient was intubated and admitted to intensive care. Comprehensive laboratory assessments revealed no abnormalities and an initial cerebral CT scan showed no acute changes. A subsequent CT scan performed 24 hours post-event disclosed bilateral ischemia affecting the territories of the anterior and middle cerebral arteries. Regrettably, this catastrophic event precluded any potential for recovery. Consequently, the decision was made not to pursue further investigations to determine the underlying cause. The medical team opted for supportive treatment and comfort measures. Tragically, the patient died on the 37th day of hospital admission.
PubMed: 38239517
DOI: 10.7759/cureus.50770 -
Frontiers in Artificial Intelligence 2023Artificial intelligence (AI) technology has made rapid progress for disease diagnosis and triage. In the field of ophthalmic diseases, image-based diagnosis has achieved...
Development and evaluation of multimodal AI for diagnosis and triage of ophthalmic diseases using ChatGPT and anterior segment images: protocol for a two-stage cross-sectional study.
INTRODUCTION
Artificial intelligence (AI) technology has made rapid progress for disease diagnosis and triage. In the field of ophthalmic diseases, image-based diagnosis has achieved high accuracy but still encounters limitations due to the lack of medical history. The emergence of ChatGPT enables human-computer interaction, allowing for the development of a multimodal AI system that integrates interactive text and image information.
OBJECTIVE
To develop a multimodal AI system using ChatGPT and anterior segment images for diagnosing and triaging ophthalmic diseases. To assess the AI system's performance through a two-stage cross-sectional study, starting with silent evaluation and followed by early clinical evaluation in outpatient clinics.
METHODS AND ANALYSIS
Our study will be conducted across three distinct centers in Shanghai, Nanjing, and Suqian. The development of the smartphone-based multimodal AI system will take place in Shanghai with the goal of achieving ≥90% sensitivity and ≥95% specificity for diagnosing and triaging ophthalmic diseases. The first stage of the cross-sectional study will explore the system's performance in Shanghai's outpatient clinics. Medical histories will be collected without patient interaction, and anterior segment images will be captured using slit lamp equipment. This stage aims for ≥85% sensitivity and ≥95% specificity with a sample size of 100 patients. The second stage will take place at three locations, with Shanghai serving as the internal validation dataset, and Nanjing and Suqian as the external validation dataset. Medical history will be collected through patient interviews, and anterior segment images will be captured via smartphone devices. An expert panel will establish reference standards and assess AI accuracy for diagnosis and triage throughout all stages. A one-vs.-rest strategy will be used for data analysis, and a power calculation will be performed to evaluate the impact of disease types on AI performance.
DISCUSSION
Our study may provide a user-friendly smartphone-based multimodal AI system for diagnosis and triage of ophthalmic diseases. This innovative system may support early detection of ocular abnormalities, facilitate establishment of a tiered healthcare system, and reduce the burdens on tertiary facilities.
TRIAL REGISTRATION
The study was registered in ClinicalTrials.gov on June 25th, 2023 (NCT05930444).
PubMed: 38145231
DOI: 10.3389/frai.2023.1323924 -
Journal of Abdominal Wall Surgery : JAWS 2023Women in medicine and surgery are a recent phenomenon. The aim of this study was to review the modern history of pioneering women in medicine and surgery in Scotland.... (Review)
Review
Women in medicine and surgery are a recent phenomenon. The aim of this study was to review the modern history of pioneering women in medicine and surgery in Scotland. A variety of sources were searched including Google, PubMed, and the Royal College of Surgeons of Edinburgh publications to source the material for this paper. Despite over five centuries of Scottish universities offering medical degrees, women have only had the right to study medicine for 150 years. However, the lives of women pioneers who either circumnavigated or surmounted this inequality, namely, "James Barry" and Sophia Jex-Blake, are briefly told. Doctors today owe a debt to those who pushed the boundaries, challenged the unfair rules and tackled institutional gender inequality in medicine. Reading about their lives and work is uplifting.
PubMed: 38312431
DOI: 10.3389/jaws.2023.11227 -
Journal of Pharmacy & Bioallied Sciences Feb 2024The rise of Islam in Arabia witnessed a scientific pursuit from 8 CE to 14 CE in its vast dominion. Medicine was one among many disciplines that was reshaped during the... (Review)
Review
The rise of Islam in Arabia witnessed a scientific pursuit from 8 CE to 14 CE in its vast dominion. Medicine was one among many disciplines that was reshaped during the golden ages of Islamic world. Physicians and scholars from diverse faiths and background flocked in learning centers of Baghdad, Cordoba, and other cities. A multicultural environment of medical research was evolved with fundings from state. From medical teaching and clinical training to the licensing of physicians, many of the modern attributes of medical education were pioneered in Islamic world. The scholarly transfusion from European territories of Islamic world to the Western world in medieval era laid the foundation of modern medical education.
PubMed: 38595522
DOI: 10.4103/jpbs.jpbs_969_23