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]
Evidence-based practice is the first step in underpinning and shaping how the profession delivers patient care. The Oxford Dictionary defines evidence as: ‘the available body of facts or information indicating whether a belief or proposition is true or valid’. The majority of evidence, though not all, is provided by research studies published in professional journals. Best evidence should be of high quality and is thus founded on the status of publishing journals and the process by which journals, editors and the editorial team separate out the “good” from both the “mediocre” and the “bad”.
This is undertaken by the process of Peer reviewing or refereeing; it is the practice of critically examining an author’s submitted research manuscript by experts in the same field before a paper is accepted for publishing in a journal. When well done, it confers a stamp of approval to the substance, authenticity, and value of articles and therefore is a crucial element, integral to scholarly research and the validation of published evidence. [More]
Planning for a disaster must anticipate how demands imposed by a disaster equate with the capacity of the available facilities. Resources must be organized before an event occurs so that they are best prepared in every way to treat as many victims as possible. The actual number of victims is less relevant than the extent receiving facility can be adjusted to meet the appropriate requirements of victims. Multiple casualty incidents (MCIs) are defined as a large number of casualties generated over a short period that are appropriately managed with existing or extended resources. Mass casualty events (MCEs), in contrast, are major medical disasters that erode organized community support mechanisms and result in casualty numbers which overwhelm resources .
Due to the increased frequency and impact of disasters, including natural disasters, pandemics and terrorism, the concept of disaster resilience is accepted as being of increasing importance.
The notion of resilience can be defined as the capacity to adapt to unexpected challenges and the flexibility to revert to normality. Additionally, the issues learned from the experience should be incorporated into protocols which would allow for better preparedness for future challenges [2,3]. [More]
Mankind has been and still is constantly threatened by infectious diseases. Antimicrobials, used to treat infections, are considered one of the greatest discoveries of the 20th century because they saved millions of lives from diseases that had a high mortality rate. Mankind has been and is still constantly threatened by infectious diseases. Antimicrobials, used to treat infections, are considered one of the greatest discoveries of the 20th century because they saved millions of lives from diseases that had a high mortality rate. Current infectious pathology is worryingly extending due mainly to “globalization”, which confirms the current concept of “Infections Without Borders”. In this context, both the consumption of antimicrobial substances and, inherently, the resistance of the main pathogens involved have increased. Unfortunately, antimicrobials have become victims of their success because their abusive use in humans and animals has led to the emergence of resistance among clinically important pathogens. Each dose of antibiotic creates selective evolutionary pressures, resulting in pandemic spread of highly resistant bacterial clones. Resistance to antibiotics is one of the greatest threats to human health. A return to the pre-antibiotic era would not only make possible the development of epidemics caused by multidrug-resistant bacteria, a major threat to the population, but would also jeopardize some of the most valuable therapies in modern medicine, such as transplantation and immunosuppressive chemotherapy programmes –dependent on supportive antimicrobial treatments. [More]