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By: Carl M. Pearson Professor of Rheumatology, Director, Rheumatology Clinical Research Center, Department of Rheumatology, University of California, Los Angeles
Thus the position attributed to Diocles here corresponds closely with that attributed to him by Galen in fr order generic malegra dxt plus canada erectile dysfunction treatment in vijayawada. This would suggest that Galen is referring to how foods and drinks are ultimately disposed of; but this would seem to be quite inappropriate to the context cheap malegra dxt plus online amex erectile dysfunction 32. Principles and practices of therapeutics in the Hippocratic Corpus and in the work of Diocles of Carystus 1 introduction In a well-known passage from the Hippocratic Epidemics order genuine malegra dxt plus on-line erectile dysfunction medications in india, the doctor’s duties are succinctly characterised as follows: [The doctor should] declare what has happened before buy 5 mg propecia with amex, understand what is present amoxil 500mg for sale, and foretell what will happen in the future cytotec 100 mcg for sale. As to diseases, he should strive to achieve two things: to help, or to do no harm. The (medical) art consists of three components: the disease, the patient, and the doctor. It is succinctly summarised here in the words ‘to help, or to do no harm’ (Ýfele±n £ m blptein), a formula which is often quoted or echoed both in the Hippocratic Corpus and in later Greek and Roman medical literature. The Hippocratic Oath, which explicitly mentions the well-being of the patient as the doctor’s This chapter was ﬁrst published in slightly different form in I. Thus, according to the Oath, the doctor is not allowed to give a woman an abortive, nor to administer a lethal poison, not even when being asked to do so; and the doctor is instructed to refrain from every kind of abuse of the relation of trust that exists between him and the patient. Yet it is also possible – as the word ‘or’ suggests – to take the formula in the sense of unintended harm: ‘To help, or at least to cause no harm’, that is to say, the doctor should be careful when treating the patient not to aggravate the patient’s condition, for example in cases that are so hopeless that treatment will only make matters worse, or in cases which are so difﬁcult that the doctor may fail in the execution of his art; and as we shall see, there is evidence that Greek doctors considered this possibility too. In this chapter I will examine how this principle ‘to help, or to do no harm’ is interpreted in Greek medical practice and applied in cases where it is not immediately obvious what ‘helping’ or ‘causing harm’ consists in. I will study this question by considering the therapeutic sections of a number of Hippocratic writings (most of which date from the period 425–350 bce) and in the fragments of the fourth-century bce medical writer Diocles of Carystus. This passage has received ample attention in scholarship, and it is not my in- tention to give a detailed interpretation or an assessment of its historical reliability. By this I mean the position and relative importance of therapeutics within the ﬁeld of medicine as a whole, which gives rise to 3 ‘I will use dietetic measures to the beneﬁt of the patients... I will keep them from harm and injustice’ (diaitmas© te crsomai pì Ýfele©h tän kamn»ntwn... For more general assessments of Celsus as a source for the history of medicine see Smith (1979) 226–30 and (1989) 74–80; von Staden (1994b) 77–101 and (1999b); Stok (1994) 63–75; Temkin (1935) 249–64. To help, or to do no harm 103 questions such as the following: Are therapeutics and medicine identical? Or is therapeutics a part of medicine, or perhaps an aim (or even the aim) of medicine? Do they all have the same purpose, and are they all considered to be equally important? Is there a special status for dietetics (which does not necessarily aim at healing)? The answers to these questions are by no means obvious, yet they are of fundamental importance to an understanding of what Greek doctors of this period were up to and what they believed the purposes of their activities to be. As is well known, in sections 5–8 of the proem Celsus discusses the early period when the medical art was – in Celsus’ view perniciously – incorporated within the theoretical study of the nature of things (rerum naturae contemplatio) and he presents, with obvious approval, Hippocrates as the one who emancipated medicine out of the bondage of philosophy (studium sapientiae), the pursuit of knowledge for its own sake, which Celsus claims to be so fundamentally harmful to the body: Ergo etiam post eos de quibus rettuli, nulli clari uiri medicinam exercuerunt donec maiore studio litterarum disciplina agitari coepit (6) quae, ut animo praecipue omnium necessaria, sic corpori inimica est.
Also known as myofascial pain syndrome A condition that is preleukemia or smoldering leukemia cheap malegra dxt plus american express impotence after 40. Most ropractic cheap 160 mg malegra dxt plus otc erectile dysfunction pills with no side effects, and some forms of acupuncture) have forms of myopia can be managed with corrective been reported as beneficial order malegra dxt plus uk impotence research. There are many causes of myositis purchase 80mg top avana fast delivery, including injury order aurogra online, med- myoma A tumor of muscle purchase 100 mg caverta free shipping. A myringotomy can be used to drain any fluid behind the eardrum and to remove thickened myopathic pseudo-obstruction See pseudo- secretions. A myx- myopia Nearsightedness, the inability to see dis- oma is the most common type of primary tumor of tant objects well. Also known as hereditary osteo-onychodysplasia, for sodium chloride (table salt) is NaCl. Narcolepsy is often associated body, lateral nail folds on its sides, a lunula (the lit- with cataplexy (a sudden loss of muscle tone and tle moon-shaped feature at the base), and a proxi- paralysis of voluntary muscles associated with a mal skin fold at its base. See also fingernail; nail strong emotion), sleep paralysis (immobility of the care; toenail. The causes of narcolepsy include keeping nails clean and dry to keep bacte- are unknown. Narcolepsy is not a fatal disorder in ria and other infectious organisms from collecting itself, but it can lead to fatalities. For example, under the nails, cutting nails straight across with affected persons may fall asleep while driving. Also only slight rounding at the tip, using a fine-textured known as excessive daytime sleepiness, hypnolepsy, file to keep nails shaped and free of snags, and sleeping disease, paroxysmal sleep, and Gelineau avoiding nail-biting. A narcotic induces narcosis, from the Greek at drugstores, without a prescription) before trim- “narke” for “numbness or torpor. One should not “dig out” ingrown toenails, as marijuana which is subject to regulatory restric- especially if they are sore; instead, a physician tions comparable to those for addictive narcotics. Nail changes, swelling, and pain can signal serious problems that should be nares The nostrils. Decongestants can be taken orally or as plate caused by temporary cessation of cell division nasal drops or spray. The condition may be not be used for more than 5 days in a row without a caused by local disease of the nail fold, physical physician’s consent. When nasal decongestants are trauma to it, or a systemic insult, such as an illness used for a long time and then discontinued, symp- or a drug as, for example, chemotherapy. The walls of the nasal passages are coated is a flexible tube made of rubber or plastic, and it with respiratory mucous membranes, which contain has bidirectional potential. It can be used to remove innumerable tiny hair-like cells that move waves of the contents of the stomach, including air, to mucus toward the throat.
Rita Konyves for typing meticulously and conscientiously the major part of the manuscript and to Mrs cheap malegra dxt plus 160mg online erectile dysfunction kidney failure. My sincere thanks and gratitude are due to Robert Albano malegra dxt plus 160 mg cheap impotence from smoking, Senior Clin- ical Medical Editor of Springer cheap 160 mg malegra dxt plus otc impotence natural remedies, for his constant support and encourage- ment buy discount extra super avana 260 mg, and to others at Springer for their help in the successful completion of the book order cialis cheap. These two entities are interchangeable and exist in different forms to make up all things visible or invisible in the universe buy extra super viagra with a mastercard. Whereas matter has a deﬁnite size, shape, and form, energy has different forms but no size and shape. Matter is characterized by its quantity, called the mass, and is composed of the smallest unit, the atom. In atomic physics, the unit of mass is the atomic mass unit (amu), which is equal to 1. Energy is the capacity to do work and can exist in several forms: kinetic energy (which is due to the motion of matter); potential energy (which is due to the position and conﬁguration of matter); thermal energy (which is due to the motion of atoms or molecules in matter); electrical energy (which is due to the ﬂow of electrons across an electric potential); chemical energy (which is due to chemical reaction); and radiation (energy in motion). Of all these forms, radiation is of great importance in nuclear medicine and, therefore, will be discussed in detail. Mass and energy are interchangeable, and one is created at the expense of the other. This relationship states that every- thing around us can be classiﬁed as matter or energy. Particulate radiations: Examples of these radiations are energetic elec- trons, protons, neutrons, a-particles, and so forth. The particulate radiations originate from radioactive decay, cosmic rays, nuclear reactions, and so forth. Electromagnetic radiations: These radiations are a form of energy in motion that does not have mass and charge and can propagate as either waves or discrete packets of energy, called the photons or quanta. Various examples of electromagnetic radiations include radio waves, visible light, heat waves, g-radiations, and so forth, and they differ from each other in wavelength and hence in energy. The energy of an electromagnetic radiation is given in electron volts (eV), which is deﬁned as the energy acquired by an electron when acceler- ated through a potential difference of 1 volt. The Atom For the purpose of this book, the atom can be considered as the smallest unit in the composition of matter. The atom is composed of a nucleus at the center and one or more electrons orbiting around the nucleus. The protons and neutrons are about 1836 times heavier than the electrons but the neutron is heavier than the proton by one electron mass (i. The number of electrons is equal to the number of protons, thus resulting in a neutral atom of an element. The size of the atom is about 10−8cm (called −13 the angstrom, Å), whereas the nucleus has the size of 10 cm (termed the 14 3 fermi, F). The elec- tronic arrangement determines the chemical properties of an element, whereas the nuclear structure dictates the stability and radioactive trans- formation of the atom.
Pain measurement scales can be used differently across individuals based on the past pain experiences of individuals purchase 160mg malegra dxt plus with amex erectile dysfunction effexor xr. The outcomes of clinical trials are based on the mean responses of large numbers of subjects but fail to address inter-individual differences purchase malegra dxt plus 160mg with amex erectile dysfunction pills walmart. Universal Free E-Book Store Personalized Management of Pain 447 Clinical diagnosis of Pharmacogenetics Pharmacogenomics type of pain & cause of analgesics of pain syndromes Pharmaco- Personalized Mechanism-based diagnostics of pain Pain drug discovery Management Conditioned pain modulation status Targeted delivery of Selection of best of patient therapy for pain treatment (s) for patient © Jain PharmaBiotech Fig discount malegra dxt plus master card impotence bicycle seat. Pharmacogenetics has the potential to improve patient therapy and care purchase silagra 100 mg free shipping, and it is hoped that it will individualize drug treatment to a greater extent in the near future (Stamer and Stuber 2007 ) 200mg extra super viagra free shipping. To address these issues buy on line tadalis sx, basic science research is beginning to identify the allelic variants that underlie such antinociceptive variability using a multiplicity of animal models, and powerful genetic approaches are being exploited to accelerate this pro- cess. Although the vast majority of these studies have focused on the pharmacoge- netics of opioids, owing to their prominent status as analgesics, the number of pharmacotherapies reﬂecting genetically-based variability is rapidly expanding. In addition, analogous studies have been undertaken in humans, as a small but grow- ing number of clinical trials have begun to evaluate prospectively the existence, often not the origin, of interindividual differences in analgesic drug response. Presentation of the spectrum of individual responses and associated prediction intervals in clinical trials can convey clinically meaningful information regarding the impact of a pain treatment on health-related quality of life. Individual responder analyses are proposed for use in clinical trials to better detect analgesic activity across patient groups and within sub-groups, and to identify molecular-genetic mechanisms that contribute to individual variation. Studies have shown that people with red hair need 20 % more general anesthesia than blonds and brunettes. Redheads are also more sensitive to thermal pain and are more resistant to the effects of local anesthesia. While blond, brown and black-haired people produce melanin, those with red hair have a mutation of this receptor that produces a different coloring called pheomelanin, which results in freckles, fair skin and red hair. In conclusion, a number of genetic variants that prevent pain by decreasing nociception or increas- ing analgesia have been identiﬁed. Given the complex biological and psychological nature of pain, the interindividual variance in pain and analgesia due to identiﬁable genetic causes, should be taken into consideration in personalizing pain therapy. Pharmacogenetics/Pharmacogenomics of Pain More recently, there has been a growing body of evidence demonstrating differ- ences in analgesic response to various pharmacotherapies, although the source of this variability largely remains to be explained. To this end, basic science research is beginning to identify the allelic variants that underlie such antinociceptive vari- ability using a multiplicity of animal models, and powerful genetic approaches are being exploited to accelerate this process. There is already a growing body of evi- dence demonstrating differences in analgesic response to various pharmacothera- pies, although the source of this variability largely remains to be explained. P450 isoforms involved in the metabolism of some drugs used in the management of pain are shown in Table 12. In addition, analogous studies have been undertaken in humans, as a small but grow- ing number of clinical trials have begun to evaluate prospectively the existence, if often not the origin, of interindividual differences in analgesic drug response. Presentation of the spectrum of individual responses and associated prediction Universal Free E-Book Store Personalized Management of Pain 449 Table 12. Individual responder analyses in clinical trials can improve detection of analgesic activity across patient groups and within sub-groups, and identify molecular-genetic mechanisms that contribute to individual variation.