One of the most revolutionary discoveries of modern medicine was organ transplantation, as it brought hope and healing in cases that seemed incurable. Best outcomes in organ transplantation are related to a rigorous tissue typing and an appropriate immunosuppressant therapy that allowed a longer survival rate for recipients . The management of the potential brain-dead donor is a complex one that involves several well-defined stages: early identification of potential donors, brain death determination, maintaining vital functions, and graft transplantation.
Brain death determination is synonymous with irreversible anatomical and functional injury to the entire brain and brainstem. This process involves a major alteration of the hemodynamic and hormonal homeostasis. Hypothalamic irreversible injury is followed by a profound normothermia dysregulation. The aggressive inflammatory response after brain death occurrence is responsible for capillary leakage and refractory hypotension . Clinical diagnostic tests that assess brain death include brain stem areflexia, apnea, and cerebral unresponsiveness, linked with a known, irreversible cause of coma .[More]
Starting in Wuhan, China , the infection caused by the novel SARS-CoV-2 virus became a public health issue when, due to the extreme contagiousness of this virus, a pandemic has been declared , putting a strain on both the global medical staff as well as the authorities in an effort to better manage an unprecedented situation in the modern era. Looking at the society we are living in, we can easily see that the COVID-19 pandemic has brought impressive social, economic, political, cultural and medical changes as well as personal ones; I believe that the perspectives and priorities of many of us have changed.
Before discussing the transplant activity, mainly the one regarding diagnosis and maintenance of the brain-dead organ donor patient, an activity that has been carried out for many years in Anesthesiology and Intensive Care Clinics, to which many of us are devoted, practicing it with deep respect, we need to review the daily activity. As is well known, the work effort in intensive care units is extremely demanding both mentally and physically. It involves the care of critical patients with severe decompensated pathologies, requiring maximum therapeutic management, special attention, continuous specific monitoring as well as the use of advanced medical and pharmacological techniques. The new measures and regulations, personal protective equipment, structural changes and working protocols implemented to prevent and limit COVID-19 infection, as well as the rigors imposed by the care of these patients have created additional stress for the medical staff. [More]
As we are writing this editorial 12 months following the publication of “The 2019 Novel Coronavirus: A Crown Jewel of Pandemics?”, there are 96 million cases with over 2 million total deaths, a public health tragedy of staggering proportions . The early stages of the pandemic were characterized by scientific uncertainty, with many authors postulating hypotheses about the transmission of SARS-CoV-2, the appropriate medical treatment, and the most effective public health measures. In retrospect, many of the early takes on coronavirus ended up being incorrect. Since January 2020, science has advanced at a breathtaking pace and the disease caused by SARS-CoV-2 has taken on dimensions few of us anticipated. In this piece, we aim to reflect on the last year, discussing aspects of the pandemic that the scientific community correctly anticipated, and highlighting where we went wrong. [More]
Since ancient times it has been known that elimination of toxins from the body helps to relieve symptoms, heal patients; for that hot baths, sweating techniques, enemas, and phlebotomy were used in the treatment of severe diseases.
Blood purification is still practiced today, but using modern techniques. The theoretical basis for the elimination of toxins by osmosis and dialysis through a semipermeable membrane was laid by Thomas Graham in the 19th century, but the first “artificial kidney”, was built and used successfully by Kolff only in 1943, in patients with acute renal failure.
Since then, blood purification has developed a lot, today it is possible to eliminate endo- and exotoxins in acute and chronic renal failure, liver failure, intoxications with various substances, but also the elimination of mediators formed in excess in sepsis and systemic inflammatory syndrome of other etiologies, and elimination of immune complexes in autoimmune and graft versus host diseases.
The development of modern medicine has imposed a new approach both in anaesthesiology and in intensive care. This is the reason why, in the last decades, more and more devices and life-support techniques were improved in order to achieve the highest medical outcomes.
Key features of the critically ill patient are severe respiratory, cardiovascular or neurological derangements, often in combination, reflected in abnormal physiological observations. All these changes converge towards the establishment of pulmonary or extrapulmonary respiratory failure requiring mechanical ventilatory support. In the current conception, mechanical ventilation does not represent a curative method for respiratory pathology, however, it represents a bridge therapy ensuring the rest and preservation of respiratory muscles, improves gas exchange and assists in maintaining a normal pH until the recovery of the patient .
Despite decades of research, there are limited therapeutic options directed towards the underlying pathological processes and supportive care with mechanical ventilation remaining the cornerstone of patient management. [More]
Therapeutic plasma exchange (TPE) is the most frequent therapeutic apheresis procedure used to remove the plasma, together with its high-molecular-weight agents such as immune complexes, antibodies, complement components, cytokines, different toxins and cryoglobulins, as well as to return of the majority of cellular components to the patients . In the hands of an experienced specialist, TPE has been found by the American Academy of Neurology to be a very important and safe tool that can improve neurological disability in patients with numerous disorders . [More]
Starting from the December 2019 identification of the 2019 novel coronavirus (2019-nCoV), an overwhelming sense of panic has enveloped public discourse. This is likely to be amplified by WHO recently declaring the novel coronavirus outbreak a public health emergency of international concern. It is the third significant occurrence of a zoonotic coronavirus crossing the species barrier to infect humans, and it likely will not be the last. Hope is not lost; and a measured approach, one that is cognizant of the seriousness of this public health crisis without giving into hysteria, is imperative. [More]
Transplantation medicine, one of the emerging major medical disciplines, encompasses a wide variety of clinical subspecialties.
The concept of replacing organs which are failing or showing insufficiency, with single or multiple organs, either artificial or from donors, is accepted in literally every clinical field
There is explosive growth in the transplant sector driven by an ever-increasing patient demand fuelled by the already well-proven efficiency of organ transplantation as an ultimate treatment for end-stage organs failure and the ever-expanding infrastructure of the transplantation industry.
The foundation of this industry rests on two pillars: transplantation medicine and transplantation science. The sheer magnitude of the progress within the transplantation industry, as it stands today, maybe best illustrated by impressive statistics and facts, accomplishments and ongoing research trends. [More]
During the previous decades, the practice of cancer prevention and intervention has achieved much success at the population level. However, it has become obvious that such achievements at the individual levels have been highly variable and, perhaps, disappointing. Therefore, to significantly improve efficacy, the United States and the European Union have set up priority programs on the development of precision population health and personalized medicine. The emphasis will require a paradigm shift in focusing these activities onto individuals instead of populations. In addition, it changes our traditional approach in conducting basic research and clinical medicine, e.g. by incorporating more genomic information and more personal data into research and practice activities. [More]
There is a complex relationship between potential authors, especially those with limited experience in submitting manuscripts, medical journals, editors and the reviewers who participate in the peer review system. There is growing pressure on young graduates undertaking PhD and Master programs to publish papers, as the regulations for the completion of these degrees from many universities require papers to be published before the awarding of these degrees. The pressure to publish is nonetheless high, as colleagues proceed through their career pathway, with publications often dictating successful advancement or promotion. This paper highlights this complex relationship and discusses the responsibilities of all stakeholders, both ethically and professionally. [More]