Journal of Internal Medicine: Science & Art

Precision Medicine in Hepatobiliary Diseases: A Clinical Review.

Naresh Bansal — 2024-07-10

This review delves into the molecular intricacies of hepatobiliary diseases, emphasizing their genetic and molecular foundations. It explores the expanding scope of precision medicine, advocating for tailored approaches based on individual genomic profiles to enhance diagnostic and therapeutic strategies. The genetic and molecular basis of conditions such as hepatitis and cirrhosis are dissected, revealing specific mutations' roles in susceptibility and disease progression. The narrative underscores precision medicine's potential in steering hepatobiliary medicine toward personalized, effective healthcare models. Overall, advancements in genomic research promise targeted interventions for improved outcomes in managing complex hepatobiliary disorders.

Overview of Brown-Sequard Syndrome.

Evelyn Sharon — 2024-04-16

A neurologic syndrome called Brown-Séquard syndrome is brought on by spinal cord hemisection. On the side of the body, ipsilateral to the lesion, it presents as weakness or paralysis, proprioceptive abnormalities, and loss of pain and temperature perception. Brown-Séquard syndrome is an incomplete spinal cord syndrome with a range of severity in its clinical presentation.

One of the most intricate and fascinating areas of the nervous system to study is the spinal cord. Its overwhelming clinical presentation, development problems, lesions, and intricate connections call for a deeper comprehension of its anatomical and physiological makeup.

Like the brain, the extremely fragile and sensitive spinal cord is well-protected by the robust bony cage comprising the vertebral arch and vertebral bodies. Together, they create the spinal hollow, or long spinal column, which houses the spinal cord. Millions of neurons reside in the spinal cord, and their bundled fibers run as ascending or descending tracts. Thirty-one pairs of spinal nerves, primarily supplying the trunk and limbs, emerge from the spinal cord. These are mixed spinal nerves with a motor component that assists in controlling the trunk and voluntary muscles in all limbs. Additionally, they have a sensory component that aids in taking in the sensory data from these regions. Therefore, for a better understanding of the clinical presentation and its pathology in any spinal cord lesion, it is imperative to grasp the fundamentals of anatomy.

In this short review, we have discussed the symptoms, management, and prevention of brown syndrome.

The Impact of Ramadan Fasting on Sleep and Treatment Compliance in Psychiatric Patients: A Survey Study.

Marwa Ben Mbarek — 2024-04-08

Background: During Ramadan, fasting is a duty for all healthy adult Muslims. During this month, there is a major and abrupt break in chrono-biological rhythms, sleep duration and timing, and the activity/rest cycle.

Aims: This study aims to explore the impact of the month of Ramadan, with its various biological, behavioral, and social repercussions, on mental health in Tunisian psychiatric patients who may or may not be fasting.

Objective: To determine the impact of the month of Ramadan on sleep and treatment compliance in psychiatric patients.

Methods: This was a survey study of all patients under follow-up at the Monastir psychiatric outpatient department for mental disorders, with two measurements during and after the month of Ramadan in 2019 (i.e., from May 05 to June 04, 2019, the number of hours of fasting in Tunisia was between 15h 43 min and 16 h 36 min). The data was analyzed in 2020.

Results: After studying 107 survey responses twice, during and after Ramadan, this study shows that sleep quality was significantly impaired during Ramadan for both fasters and non-fasters. There was also a significant difference between Ramadan and post-Ramadan in terms of treatment compliance; hence, adherence to treatment in the study population depended on the Ramadan effect and not the Fasting effect.

Conclusion: This study showed that sleep quality assessed by the ISI insomnia scale was significantly impaired during the month of Ramadan for both fasting and non-fasting subjects. Also, adherence to treatment in the study population depended on the Ramadan effect and not the fasting effect.

Medicine in the 21st Century: How Not to Lose the Art of Healing?

Tetyana Anastasiivna Khomazyuk — 2024-05-12

In our time of advanced technologies, the Internet, and the enormous acceleration of all areas of humanitarian activity, medical scientists make outstanding discoveries and innovations that revolutionize diagnostic approaches and treatment options, improve patient care, and enrich the way to a healthier world. Is there still a place for the art of medicine in the era of innovations and artificial intelligence?

Although modern technology in the field of medicine with computerization of every aspect (including electronic medical records, laboratory data entry, images, patients' monitoring systems, etc.), young physicians, while embracing that innovation, should be trained in the development of clinical thinking and the establishment of personalized connections to the patients. Young physicians should be taught to adopt the ability to see, hear, and feel a patient's problems, formulate optimal management, and be empathetic to the patient's emotions and suffering.

Communication skills are a key to successful medical practice and a part of "the Introduction to Clinic" course in almost all medical schools, but a substantial lack of time in clinical settings creates new challenges for communication between medical students, clinical teachers, and patients in medical schools. In many areas around the world, including Ukraine, this problem has been aggravated by wars, epidemics, pandemics, and natural disasters. At the same time, developing clinical observational skills remains an integral part of medical education and the basis of medical art. The art of a careful physical exam should not be lost behind a computer screen.

Dnipro State Medical University has traditions of integrating centuries-old world historical experiences of teaching the art of healing into the philosophical concept of forming the critical clinical thinking of medical students. Our medical school has incorporated "diagnosing the canvas" into its curriculum. A thematic gallery of diagnostic symptoms and signs from great artists of all times and peoples has been created, expanding the young physicians' educational horizons in clinical thinking, empathy, and mercy.