Alanine aminotransferase predicts incident steatotic liver disease of metabolic etiology: Long life to the old biomarker!

Alanine aminotransferase (ALT) serum levels increase because of hepatocellular damage. Metabolic dysfunction-associated fatty liver disease (MAFLD), which identifies steatotic liver disease (SLD) associated with ≥ 2 metabolic abnormalities, has prominent sexual differences. The Metabolic Syndrome defines a cluster comprising abdominal obesity, altered glucose metabolism, dyslipidemia, and hypertension. Male sex, body mass index, glucose, lipids, ferritin, hypertension, and age independently predict ALT levels among blood donors. Over the last few decades, the reference range of ALT levels has been animatedly debated owing to attempts to update sex-specific reference ranges. With this backset, Chen et al have recently published a study which has two main findings. First, > 80% of individuals with MAFLD had normal ALT levels. Second, there was a linear increasing trend in the association between cumulative excess high-normal ALT levels and the rate of incident MAFLD. This study has biologically credible findings. However, it inaccurately considered sex differences in the MAFLD arena. Therefore, future studies on SLD owing to metabolic dysfunction should adopt locally determined and prospectively validated reference ranges of ALT and carefully consider sex differences in liver enzymes and MAFLD pathobiology.

Picasso's Science and Charity and the evolution of the medical art.

The present article reflects on the evolution of clinical medicine throughout time by commenting on Picasso's painting Science and Charity (1897) through a biomedical lens. The two souls of medicine, namely the cold scientific one and the compassionate one, are examined in their dichotomy and their relationship with today's concepts of cure and well-being.

The Genesis of Multidisciplinary Health Professionals Teams for Pain Management. A History from the Hellenic Antiquity to Modern Palliative Medicine.

The aim of our article is to highlight the history of pain management. The multidisciplinary team (MDT) concept in confronting pain was first conceptualized by the Hippocratics, and has evolved through time and become a trend in medicine over recent decades. Documentary research was conducted to unveil the story of the evolution of MDTs. From the early 1950's the idea of an MDT approach to deal with various types of pain was sporadically introduced in medicine. Studies encouraged health institutions to support this concept by providing health professionals with training, alongside the necessary facilities and resources. Specialized care programs started with Dame Cicely Mary Strode Saunders as one of the pioneers. CONCLUSIONS: Team work and continuous interdisciplinary treatment of pain have rendered MDTs essential for health systems. Barriers in flexibility, information flow and personal issues give rise to the need for better organization and training. Pain and terminal disease palliation call for MDTs, and educated leaders to run them. Present and future health MDTs are considered necessary in all medical fields.

Assessing the impact of history of medicine research: A scientometric and altmetric analysis.

Background and Aims: After conducting a comprehensive literature search of two medical electronic databases, PubMed and Embase, as well as two citation databases, Web of Science Core Collections (WoS) and Scopus, we aimed to conduct an Altmetric and Scientometric analysis of the History of Medicine literature in medical research. Methods: The following software tools were used for analyzing the retrieved records from PubMed and Embase databases and conducting a collaboration analysis to identify the countries involved in scientific medical papers, as well as clustering keywords to reveal the trend of History of Medicine research for the future. These software tools (VOSviewer 1.6.18 and Spss 16) allowed the researchers to visualize bibliometric networks, perform statistical analysis, and identify patterns and trends in the data. Results: Our analysis revealed 53,771 records from PubMed and 54,405 records from EMBASE databases retrieved in the field of History of Medicine by 105,286 contributed authors in WoS. We identified 157 countries that collaborated on scientific medical papers. By clustering 59,995 keywords, we were able to reveal the trend of History of Medicine research for the future. Our findings showed a positive association between traditional bibliometrics and social media metrics such as the Altmetric Attention Score in the History of Medicine literature (p < 0.05). Conclusion: Sharing research findings of articles in social scientific networks will increase the visibility of scientific works in History of Medicine research, which is one of the most important factors influencing the citation of articles. Additionally, our overview of the literature in the medical field allowed us to identify and examine gaps in the History of Medicine research.

Zidovudine, a brief history before the first antirretroviral in Mexico.

In the 1980s in Mexico, that of the «moral renewal¼, there was the opening to the market and the manifestation of human immunodeficiency virus (HIV) and AIDS. In this writing, the historical and therapeutic conditions are related to alleviate the syndrome until the arrival of the first antiretroviral. It is a reconstruction of the events, of which the medical-social, main clinical manifestations and of course the pharmacological therapy, until de the development zidovudina or azidotimidina of AZT, the first antiretroviral to be approved. Nevertheless, in the Mexican context, this event wasn't decisive to significantly change the morbility and the mortality.

En el México de la década de 1980, el de la «renovación moral¼, se vivió la apertura al mercado y la manifestación del virus de la inmunodeficiencia humana (VIH) y el sida. En este escrito se relatan las condiciones históricas y terapéuticas del síndrome en los pacientes mexicanos, hasta la llegada del primer antirretroviral. Se trata de una reconstrucción de los hechos, de los cuales se ha profundizado en aspectos médico-sociales, principales manifestaciones clínicas y terapéutica farmacológica, hasta que interviene en la patogenia del VIH/sida el desarrollo de la zidovudina o azidotimidina (AZT), primer antirretroviral en ser aprobado. No obstante, en el contexto mexicano este suceso no fue determinante para cambiar de manera significativa la morbimortalidad de los infectados.

Social issues relating to Vladimir Bekhterev's concept of reflexology: a hitherto underestimated aspect of his work.

This article investigates the diversity of social and political assertions in the work of Vladimir M Bekhterev. Its findings reveal that he drew social and political conclusions based on his doctrine of reflexology. Moreover, he propagated the use of statistical investigations by scientific and governmental institutions to estimate the social and healthcare needs of the population. These conclusions accord with Bekhterev's desire for a transformation of society that would bring continued progress to people's social and living conditions. Additionally, the findings of this research work also support the idea that Bekhterev should be regarded as an important protagonist of neuroethics, a relatively recent field of research.

Evaluating the impact of an educational intervention on the history of racism in America for teaching structural competency to medical academicians.

BACKGROUND: A challenge facing many Academic Health Centers (AHCs) attempting to revise health professions education to include the impact of racism as a social and structural determinant of health (SSDoH) is a lack of broad faculty expertise to reinforce and avoid undermining learning modules addressing this topic. To encourage an institutional culture that is in line with new anti-racism instruction, we developed a six-part educational series on the history of racism in America and its impact on contemporary health inequities for teaching structural competency to health professions academicians. METHODS: We developed a six-hour elective continuing education (CE) series for faculty and staff with the following objectives: (1) describe and discuss race as a social construct; (2) describe and discuss the decolonization of the health sciences and health care; (3) describe and discuss the history of systemic racism and structural violence from a socio-ecological perspective; and (4) describe and discuss reconciliation and repair in biomedicine. The series was spread over a six-month period and each monthly lecture was followed one week later by an open discussion debriefing session. Attendees were assessed on their understanding of each objective before and after each series segment. RESULTS: We found significant increases in knowledge and understanding of each objective as the series progressed. Attendees reported that the series helped them grapple with their discomfort in a constructive manner. Self-selected attendees were overwhelmingly women (81.8%), indicating a greater willingness to engage with this material than men. CONCLUSIONS: The series provides a model for AHCs looking to promote anti-racism and structural competency among their faculty and staff.

Charcot's international visitors and pupils from Europe, the United States, and Russia.

The foundation by Jean-Martin Charcot (1825-1893) of the Salpêtrière School in Paris had an influential role in the development of neurology during the late-nineteenth century. The international aura of Charcot attracted neurologists from all parts of the world. We here present the most representative European, American, and Russian young physicians who learned from Charcot during their tutoring or visit in Paris or Charcot's travels outside France. These include neurologists from Great Britain and Ireland, the United States, Germany and Austria, Switzerland, Russia, Italy, Spain, Belgium and the Netherlands, Scandinavia and Finland, Poland, Bohemia, Hungary, and Romania. Particularly emblematic among the renowned foreign scientists who met and/or learned from Charcot were Charles-Edouard Brown-Séquard, who had interactions with Paris University and contributed to the early development of British and American neurological schools; John Hughlings Jackson, who was admired by Charcot and influenced French neurology similarly as Charcot did on British neurology; Silas Weir Mitchell, the pioneer in American neurology; Sigmund Freud, who was trained by Charcot to study patients with hysteria and then, back in Vienna, founded a new discipline called psychoanalysis; Aleksej Yakovlevich Kozhevnikov and almost all the founders of the Russian institutes of neurology who were instructed in Paris; and Georges Marinesco, who established the Romanian school of neurology and did major contributions thanks to his valuable relation with Charcot and French neurology.

Lessons for Cardiovascular Clinical Investigators: The Tumultuous 2,500-Year Journey of Physicians Who Ignited Our Fire.

Whereas medical practice stems from Hippocrates, cardiovascular science originates with Aristotle. The Hippocratic philosophy was championed by Galen (129-216 CE), whose advocacy of a tripartite soul found favor in the early Christian Church. In contrast, Aristotle's works were banned as heresy by ecclesiastical authority, only to survive and prosper in the Islamic Golden Age (775-1258 CE). Galen theorized that the circulation consisted of separate venous and arterial systems. Blood was produced in the liver and traveled centrifugally through veins. When arriving in the right ventricle, venous blood passed through tiny pores in the ventricular septum into the left ventricle, where it became aerated by air passing from the lungs through the pulmonary veins to the left side of the heart. Following arrival at distal sites, arterial blood disappeared, being consumed by the tissues, requiring that the liver needed to continually synthesize new blood. The heart was viewed as a sucking organ, and the peripheral pulse was deemed to result from changes in arterial tone, rather than cardiac systole. Galen's framework remained undisputed and dominated medical thought for 1,300 years, but the reintroduction of Aristotelian principles from the Islamic world into Europe (through the efforts of the Toledo School of Translators) were nurtured by the academic freedom and iconoclastic environment uniquely cultivated at the University of Padua, made possible by Venetian rebellion against papal authority. At Padua, the work of Andreas Vesalius, Realdo Colombo, Hieronymus Fabricius ab Acquapendente, and William Harvey (1543-1628) methodically destroyed Galen's model, leading to the modern concept of a closed-ended circulation. Yet, due to political forces, Harvey was ridiculed, as was James Lind, who performed the first prospective controlled trial, involving citrus fruits for scurvy (1747); it took nearly 50 years for his work to be accepted. Even the work of William Withering (1785), the father of cardiovascular pharmacology, was tarnished by professional jealously and the marketing campaign of a pharmaceutical company. Today's cardiovascular investigators should understand that major advances are routinely derided by the medical establishment for political or personal reasons; and it may take decades or centuries for important work to be accepted.

Her Legacy Lives On: Celebrating the Women Behind Head and Neck Eponyms.

This article profiles 6 notable female scientists who have had eponyms named after them, highlighting their significant contributions to various medical fields and whose scientific endeavors have influenced our practice and understanding of otolaryngology. We discuss Lucja Frey Gottesman and her description of Frey's syndrome; Margaret Dix and the Dix-Hallpike test; Lotte Strauss and her work defining Churg-Strauss disease; Dorothy Reed Mendenhall's discovery of Reed-Sternberg cells in Hodgkin's lymphoma; Edith Louise Potter defining Potter sequence in utero; Denise Louis-Bar originally characterizing the condition now known as ataxia-telangiectasia or Louis-Bar syndrome. Despite the challenges these women faced as pioneering female physicians as well as personal and political turmoil, their contributions greatly advanced the fields of otolaryngology, neurology, neuropathology, perinatology, and pediatric pathology. We aim to honor their stories and medical legacies.

[Dr. Valentin Grandis and Dr. Virgilio Ducceschi, two italian masters who initiated Experimental Physiology at the Faculty of Medical Sciences - Universidad Nacional De Cordoba (Argentina)] / Dr. Valentin Grandis y Dr. Virgilio Ducceschi, Dos maestros italianos iniciadores de la Fisiología experimental en la Facultad de Ciencias Médicas - UNC.

This paper examines the significant contribution of Dr. Valentín Grandis and Dr. Virgilio Ducceschi to the founding and development of experimental physiology at the Faculty of Medical Sciences of the National University of Córdoba (UNC), Argentina. Although the most notable contribution to the field of experimental physiology in Argentina is attributed to Bernardo Alberto Houssay, this study highlights the importance of the previous and fundamental efforts of Grandis and Ducceschi, two Italian professors whose work in Buenos Aires and Córdoba laid the foundations for research and teaching in this discipline. The paper details how, in 1904, the arrival of Valentin Grandis at the UNC marked the formal beginning of the teaching and practice of experimental physiology at the institution, followed by the incorporation of Virgilio Ducceschi, who continued and expanded Grandis' legacy. The work of these two Italian masters involved not only the installation of a state-of-the-art laboratory but also the establishment of a solid academic and scientific foundation that would influence future generations of Argentine physicians and researchers. Through a detailed analysis of their biographies, scientific contributions, and the impact of their work, this paper illustrates how Grandis and Ducceschi were key figures in the development of medical science in Argentina, particularly in the field of experimental physiology. Furthermore, the study highlights the importance of their educational approach and their ability to train disciples who would continue their research, thus ensuring the permanence of their legacy at the National University of Córdoba and in Argentine science in general. In conclusion, this paper vindicates and celebrates the contributions of Valentín Grandis and Virgilio Ducceschi to the initiation of research and experimentation in physiology and biological chemistry at the UNC, highlighting their importance in the advancement of medicine and science in Argentina.

Este trabajo examina el significativo aporte de los doctores Valentín Grandis y Virgilio Ducceschi a la fundación y desarrollo de la fisiología experimental en la Facultad de Ciencias Médicas de la Universidad Nacional de Córdoba (UNC), Argentina. A pesar de que la contribución más notable en el campo de la fisiología experimental en Argentina se atribuye a Bernardo Alberto Houssay, este estudio destaca la importancia de los esfuerzos previos y fundamentales de Grandis y Ducceschi, dos profesores italianos cuyo trabajo en Buenos Aires y Córdoba sentó las bases para la investigación y la enseñanza de esta disciplina.   El trabajo detalla cómo, en 1904, la llegada de Valentín Grandis a la UNC marcó el inicio formal de la enseñanza y práctica de la fisiología experimental en la institución, seguida por la incorporación de Virgilio Ducceschi, quien continuó y expandió el legado de Grandis. La labor de estos dos maestros italianos no solo involucró la instalación de un laboratorio de vanguardia sino también el establecimiento de una sólida base académica y científica que influiría en generaciones futuras de médicos e investigadores argentinos.   A través de un análisis detallado de sus biografías, contribuciones científicas, y el impacto de su trabajo, este documento ilustra cómo Grandis y Ducceschi fueron figuras clave en el desarrollo de la ciencia médica en Argentina, particularmente en el ámbito de la fisiología experimental. Además, el estudio resalta la importancia de su enfoque educativo y su capacidad para formar discípulos que continuarían sus investigaciones, asegurando así la permanencia de su legado en la Universidad Nacional de Córdoba y en la ciencia argentina en general.   En conclusión, el presente trabajo reivindica y celebra las contribuciones de Valentín Grandis y Virgilio Ducceschi al inicio de la investigación y experimentación en fisiología y química biológica en la UNC, subrayando su importancia en el avance de la medicina y la ciencia en Argentina.

The human malaria-Aotus monkey model: a historical perspective in antimalarial chemotherapy research at the Gorgas Memorial Laboratory-Panama.

The human malaria-Aotus monkey model has served the malaria research community since its inception in 1966 at the Gorgas Memorial Laboratory (GML) in Panama. Spanning over five decades, this model has been instrumental in evaluating the in vivo efficacy and pharmacokinetics of a wide array of candidate antimalarial drugs, whether used singly or in combination. The animal model could be infected with drug-resistant and susceptible Plasmodium falciparum and Plasmodium vivax strains that follow a characteristic and reproducible course of infection, remarkably like human untreated and treated infections. Over the years, the model has enabled the evaluation of several synthetic and semisynthetic endoperoxides, for instance, artelinic acid, artesunate, artemether, arteether, and artemisone. These compounds have been evaluated alone and in combination with long-acting partner drugs, commonly referred to as artemisinin-based combination therapies, which are recommended as first-line treatment against uncomplicated malaria. Further, the model has also supported the evaluation of the primaquine analog tafenoquine against blood stages of P. vivax, contributing to its progression to clinical trials and eventual approval. Besides, the P. falciparum/Aotus model at GML has also played a pivotal role in exploring the biology, immunology, and pathogenesis of malaria and in the characterization of drug-resistant P. falciparum and P. vivax strains. This minireview offers a historical overview of the most significant contributions made by the Panamanian owl monkey (Aotus lemurinus lemurinus) to malaria chemotherapy research.

"Women's work": Gender and the physician workforce.

Historically, the physician professional identity and the organizational structure of Western medicine have been defined by masculine norms such as authority and assertiveness. The past five decades have seen a rapid shift in the demographics of attendees as medical schools, with equal numbers of women and men matriculants for nearly twenty years. Gender as a social, cultural, and structural variable continues to influence the physician workforce. The entry of women into medicine, has had far reaching effects on the expectations of patients, the interactions of physicians with other members of the healthcare team, and the delivery of care. Redefining the culture of medicine to accommodate the diversity of the modern workforce may benefit all physician and improve the delivery of healthcare.

Medicine's Glass Slipper: The PAVAEX Boot and 20th Century Negative Pressure Therapy.

Before the 20th century, peripheral artery disease (PAD) manifested as extreme pain, chronic wounds, and, eventually, gangrene requiring amputation. Despite this, it was rarely diagnosed. However, at the turn of the century, Western medicine shifted focus from infectious to chronic illnesses, and with this change, physicians' engagement with PAD transformed. Aiming to mitigate long-term injury, physicians now worked to identify and treat vessel disease to restore meaningful blood circulation. This article explores the development and deployment of a new device resulting from this refocus, the PAssive VAscular EXerciser (PAVAEX) Boot, and its role as a creative response to a previously intractable clinical problem. The PAVAEX Boot, designed in 1933 by vascular surgeons Louis G. Herrmann and Mont R. Reid, was one of the few interventions for PAD at the time. Based on the observation that continuous negative pressure results in vasoconstriction, while short bursts transiently increase blood flow, the PAVAEX Boot utilized intermittent negative pressure to enhance peripheral vascular perfusion. Well-marketed and praised throughout the 1930s, it vanished from public writing and academic literature just 20 years later. However, negative pressure wound therapy resurged in the late 20th century, and though its inventors failed to recognize the precedent of the PAVAEX Boot, many of these devices and therapies are rooted in identical theories. We examine why the PAVAEX Boot faded from use and argue that the device remains a crucial advancement in negative pressure therapy.

[Sir Charles Bell (1774-1842) and his contribution to neurology (the 250th anniversary of the birth)]. / Ser Charl'z Bell (1774­1842) i ego vklad v nevrologiyu (k 250-letiyu so dnya rozhdeniya).

Sir Charles Bell (1774-1842) is Scottish physiologist, surgeon, artist, philosopher and anatomist. Throughout his professional career, Charles Bell made a number of important discoveries and published a large number of scientific papers. Bell first presented a detailed description of the clinical picture of facial palsy (later named after him) and a number of other neurological disorders, as well as important information about referred pain and reciprocal inhibition. Exploring the physical expression of emotions, Bell described the anatomical basis of facial expressions, which became the basis and incentive for Charles Darwin's work in this direction. Being a talented artist, the scientist himself illustrated his publications. Bell was one of the first to integrate scientific research in neuroanatomy with clinical practice. His most significant discoveries are collected in the book «The Nervous System of the Human Body¼ (1830). A number of neurological conditions and patterns were named after him.

The story of how cancer got its name.

The disease called cancer was named after the animal known as the crab. According to ancient tradition, cancer was named after the crab because of the aggressivity or obstinacy or the crab or because of the appearance of the crab's tangled legs.

Case report: Boundaries of oncological and traumatological medical care in ancient Egypt: new palaeopathological insights from two human skulls.

The present case studies report malignant neoplastic and traumatic lesions observed on two ancient Egyptian skulls held at the Duckworth Collection (Cambridge University). The analysis aims to characterise the lesions and provide a diagnosis using a methodology based on micro-CT scanning and microscopic bone surface analysis. Results pointed towards neoplastic lesions in both cases and healed severe skull trauma in one of them suggesting successful traumatological therapy. Interestingly, our analysis has identified the presence of perimortem cutmarks associated with metastatic lytic lesions in one of the skulls, indicating a potential surgical treatment attempt or postmortem medical exploration. We argue that the two cases, although not contemporary, allow a palaeopathological discussion on oncological and traumatological understanding and management of such conditions in the past. The confrontation of two potential managements represented by two different types of lesions represent a clear boundary in ancient Egyptian medical care and a milestone in the history of medicine.

Occlusion therapy for amblyopia, a historical report from 9th century Persian scholar, Ali ibn Sahl ibn Rabban al-Tabari (838-870 CE).

INTRODUCTION: This study reevaluates the historical origins of occlusion therapy for amblyopia, focusing on the contributions of the 9th-century Islamic scholar, Ali ibn Sahl ibn Rabban al-Tabari (838-870 CE). METHODS: The investigation delved into al-Tabari's writings, particularly "Firdous al-Hikma," to extract insights into his approach to addressing reduced vision in one eye.Additionally, the study examined subsequent advancements in occlusion therapy by scholars such as Thabit ibn Qurrah and Rhazes, building upon al-Tabari'sfoundational work. RESULTS: Al-Tabari's reports contain significant insights into occlusion therapy for amblyopia, predating commonly attributed origins of the treatment. Within "Firdous al-Hikma," he outlines methods for addressing reduced vision, advocating for the covering of the healthier eye to promote the function of the weaker eye. These findings highlight the pioneering efforts of al-Tabari and his contemporaries in the Islamic civilization and challenge the conventional narrative surrounding the history of occlusion therapy. Subsequent advancements by scholars such as Thabit ibn Qurrah and Rhazes expanded upon al-Tabari's work, advocating for similar therapeutic approaches within the Islamic civilization. Their contributions further solidified the practice of occlusion therapy, laying the groundwork for its continued evolution and refinement in subsequent centuries. DISCUSSION: Al-Tabari's contributions to occlusion therapy underscore the rich heritage of scientific inquiry in theIslamic civilization during the medieval period. This historical perspective sheds light on the diverse contributions to medical knowledge and practice outside of Western contexts and emphasizes the importance of recognizing and honoring these contributions in the broader history of medicine.

Pandemic Forms.

Narrative structures, though invisible to the naked eye, guide our understanding of pandemics. Like curves and graphs, we can plot them, identify their patterns and organizing principles. These structures act upon our understanding of social and biological events just as much as the rhythms of viral replication and mutation. They order not only themselves but also social and health outcomes. This essay uses narrative precision to expand beyond Charles Rosenberg's influential dramaturgic model and develops new pandemic forms, scaled from the level of an individual line break to the multi-part series: Arc, a form of sequence. Cycle, a form of repetition. Sequel, a form of elongation. Caesura, a form of break. It investigates the potentialities and limitations of these forms, how they intersect, collide, and contradict, and how analysis of these interactions contributes to a deeper understanding of pandemics, their effects, and the diverse perspectives defining their structures. In doing so, it prototypes how literary methods offer conceptual frameworks for pandemic historiography and how a transdisciplinary, medical humanities analysis produces novel understandings at the intersection of health, culture, and society.