Introduction to Pathological Physiology Lectures from Pathological Physiology

Introduction to Pathological Physiology Lectures from Pathological Physiology © Oliver Rácz 2009 - 2016 19. 9. 2021 intro. ppt 1

THE ORIGINS OF PATHOLOGICAL PHYSIOLOGY v Claude Bernard (1813 – 1878) Introduction á l’ étude de la medicine expérimentale, 1865 Younger than Pathological Anatomy v Experimental science v Synthesizing subject (genetics, biochemistry, signal transduction, molecular, subcellular & cellular aspects…) v 19. 9. 2021 intro. ppt 2

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The associaton of science and medicine is a new thing v v v Ø Vesalius – De humanis corporis fabrica, 1543 (Padova) Ambrois Paré – surgery, 1545 - 1564 Harvey – Exercitatio anatomica de motu cordis, 1628 Leeuwenhoek – Allezijne naturkundige Werken, 1696 Morgagni – De sedibus et causis morborum per anatomem indagatis, 1761 Jenner – Vaccination against smallpox, 1796 XIXth, XXth century – microbiology, biochemistry, genetics, etc. Modern diagnostic methods. Chemoterapeutics, antibiotics, insulin, etc. 19. 9. 2021 intro. ppt 5

About doctors and medicine. . . v v v Henricus Cornelius Agrippa von Nettesheim De incertitudine et vanitate scientiarum et artium liber, 1531 a bloody satire about doctors and medical “science” Desiderius Erasmus Roterodamus Declamatio E. R. in laudem artis medicine, 1518 a praise of medicine and doctors 19. 9. 2021 intro. ppt 6

Surgical instruments, Ancient Egypt & XVIth Century 19. 9. 2021 intro. ppt 7

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“LABORATORY” MEDICINE IN THE XVI – XVIIth CENTURY 19. 9. 2021 intro. ppt 11

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Pathological physiology v v Definition of basic terms – health and disease NOSOLOGY Causes and conditions of pathological processes and diseases ETIOLOGY The way from health to disease (regulation, adaptation, defense systems) PATHOGENESIS The way back to health or to nowhere SANOGENESIS, TANATOGENIS 19. 9. 2021 intro. ppt 13

Walsh Mc. Dermott; Cecil’s Textbook of Medicine is not a science but a learned profession, deeply rooted in a number of sciences and charged with the obligation to apply them for man's benefit 19. 9. 2021 intro. ppt 14

Who is ill and who is healthy ? v WHO, 1947, 1986 v Health is the state of complete physical, mental and social well-being and not merely the lack of disease or physical defects v Life in harmony with their environment and each other 19. 9. 2021 intro. ppt 15

Who is healthy according WHO? 19. 9. 2021 intro. ppt 16

Who is healthy according WHO? 19. 9. 2021 intro. ppt 17

Young man after testicular cancer treated surgically and with chemotherapy 19. 9. 2021 intro. ppt 18

LANCE ARMSTRONG GERY HALL PARAOLYMPIC GAMES 19. 9. 2021 intro. ppt 19

Health for all in year ? ? ? v v ü ü v 2000 ? (WHO 1985, 1991) Civilisation and diseases? Diseases of maladaptation (physical and psychical stres) Diseases of affluence Diseases of the poor and undereducated Devastation of nature new targets years 2000/2020 19. 9. 2021 intro. ppt civis = citizen 20

Between health and disease v Pathological findings – – v v v laboratory, biochemical abnormalities are not diseases blood pressure is a special case noninvasive imaging methods (USG, CT, NMR) faulty genes Pathological reactions and reflexes Pathological processes (inflammation, fever, oedema, etc. ) The difference between physiological & pathological is not sharp (blood clots) 19. 9. 2021 intro. ppt 21

Nosological units - 1 v v Diabetes (symptom Þ diagnosis) Diabetes mellitus and diabetes insipidus (symptom, biochemistry Þ diagnosis) Diabetes mellitus type 1. , 2. , other forms (symptom, patophysiology Þ diagnosis) Subtypes of type 2 diabetes mellitus (symptom, genomics Þ diagnosis) 19. 9. 2021 intro. ppt 22

Nosological units - 2 Sickle cell disease: 1 mutation, 1 disease but thalassemias a hemoglobinopathies ? v How many cystic fibroses? 400 ? v Is atherosclerosis disease ? (CHD) v Is obesity disease ? v 19. 9. 2021 intro. ppt 23

Stages of diseases v Classical: Ø Ø v latent (incubation time) prodromal manifest outcomes Asymptomatic stage of chronic diseases – silent form of coronary heart disease – nondiagnosed diabetes, hypertension, etc 19. 9. 2021 intro. ppt 24

Risk factors v v v Framingham study, 1949 – 1974 It is only (? ) statistics, playing with numbers Connection between epidemiological and experimental results Probability of the disease development or its existence in asymptomatic form With high cholesterol, 30 kg overweight and 20 cigarets in a day one can live 100 years (do not try!) 19. 9. 2021 intro. ppt 25

Evidence based medicine v Best practice based on current knowledge – Formulate of the problem – Find the evidence – Critical evaluation of the evidence – Practical application – Evaluation of the results v Evidence based and creative medicine 19. 9. 2021 intro. ppt 26

Evidence based is not… Statistics based v Eminence based v Evidence biased (commercial) BUT ALSO v Economy based (on the second place) v Common sense based v 19. 9. 2021 intro. ppt 27

Personalized and precision medicine ? ? ? In the past – only personalized, insufficient technology, knowledge. . v Technological revolution – depersonalization, „cases“, „guidelines“, diagnoses from lab, CT, NMR (only pictures) v Back to the individual patient including all possibilities of technology and science v 19. 9. 2021 intro. ppt 28