Umjetnost u medicini: retrospektiva anatomskih crteža Charlesa Bella

Perhaps best known for his discovery of the eponymous syndrome ‘Bell’s Palsy’, Charles Bell (1774-1842) made significant contributions to neuroscience, medical education and philosophy. Our aim was to examine his neuroanatomical drawings in the context of the era in which they were produced and their influence on future scholars. Emphasis is placed on analysing the artistic techniques employed and Bell’s unique manner of conveying both structure and function. The images discussed include those featured in his book entitled The Anatomy of the Brain: Explained in a Series of Engravings. These images can be viewed in parallel with his writing on the anatomy of the brain, in which he describes the usual manner of demonstrating neuroanatomy as ‘dull’ and ‘unmeaning’. His mastery of artistic technique complements his insightful descriptions of this prodigiously complex organ. The result is a more engaging account of neuroanatomy and an impressive display of his skill as an artist, anatomist and physician. Examining these expressive portrait-like diagrams provides greater insight into the mind of the pioneer of modern neuroscience.Iako je možda najpoznatiji po otkriću sindroma koji je po njemu nazvan Bellova paraliza, nemjerljiv je doprinos Charlesa Bella (1774.-1842.) neuroznanosti, medicinskoj izobrazbi i filozofiji. Cilj je bio istražiti neuroanatomske crteže u kontekstu vremena u kojem su nastali te njihov utjecaj na buduće znanstvenike. Naglasak je na analizi primijenjenih umjetničkih tehnika te na Bellovu jedinstvenom načinu prikazivanja strukture i funkcije. Raspravlja se o slikama koje se nalaze u njegovoj knjizi “Anatomija mozga: objašnjenje kroz niz gravura” (The Anatomy of the Brain: Explained in a Series of Engravings). Ove slike mogu se promatrati usporedno s njegovim tekstovima o anatomiji mozga u kojima on opisuje uobičajeni način prikazivanja neuroanatomije kao “dosadne” i “besmislene”. Njegova majstorska umjetnička tehnika dopunjava njegove pronicave opise ovoga silno složenoga organa. Rezultat je znatno privlačniji pogled na neuroanatomiju i dojmljiv prikaz njegove vještine kao umjetnika, anatoma i liječnika. Izučavanje ovih izražajnih dijagrama nalik portretima omogućava bolji uvid u um ovoga pionira suvremene neuroznanosti

Medicine in the 1950s in South Sudan: Amputation for a puff adder (Bitis arietans) envenomation in a child - 1954

No Abstrac

The role of artificial intelligence in surgical simulation

Artificial Intelligence (AI) plays an integral role in enhancing the quality of surgical simulation, which is increasingly becoming a popular tool for enriching the training experience of a surgeon. This spans the spectrum from facilitating preoperative planning, to intraoperative visualisation and guidance, ultimately with the aim of improving patient safety. Although arguably still in its early stages of widespread clinical application, AI technology enables personal evaluation and provides personalised feedback in surgical training simulations. Several forms of surgical visualisation technologies currently in use for anatomical education and presurgical assessment rely on different AI algorithms. However, while it is promising to see clinical examples and technological reports attesting to the efficacy of AI-supported surgical simulators, barriers to wide-spread commercialisation of such devices and software remain complex and multifactorial. High implementation and production costs, scarcity of reports evidencing the superiority of such technology, and intrinsic technological limitations remain at the forefront. As AI technology is key to driving the future of surgical simulation, this paper will review the literature delineating its current state, challenges, and prospects. In addition, a consolidated list of FDA/CE approved AI-powered medical devices for surgical simulation is presented, in order to shed light on the existing gap between academic achievements and the universal commercialisation of AI-enabled simulators. We call for further clinical assessment of AI-supported surgical simulators to support novel regulatory body approved devices and usher surgery into a new era of surgical education

Survivor-Centered Approaches to Conflict-Related Sexual Violence in International Humanitarian and Human Rights Law

This article outlines the history of international humanitarian law conflict-related sexual violence (CRSV) from the promulgation of the Lieber Code in 1863 until the adoption in 2019 of United Nations Security Council Resolution 2467. This article considers how a survivor-centered approach to CRSV has emerged, particularly since 2008. The authors identify 3 significant clinical, ethical, and legal lessons: (1) international humanitarian law, as articulated in the Geneva Conventions and other legal instruments, requires clinicians to adopt a holistic approach to care; (2) during or after any conflict in which CRSV has allegedly been inflicted, a clinician may be required to provide evidence to an official investigatory body or court; and (3) infliction of rape in any conflict may equate to commission of torture and possibly genocide, a reality which obliges every clinician to appreciate that a patient may simultaneously be a victim of human rights violations and of crimes. [Abstract copyright: Copyright 2022 American Medical Association. All Rights Reserved.

Long-term mental wellbeing and functioning after surgery for cauda equina syndrome

INTRODUCTION: Cauda Equina Syndrome (CES) can cause persisting life-changing dysfunction. There is scarce literature regarding the long-term assessment of CES symptoms, and rarer still is the impact of these symptoms on mental wellbeing investigated. This study assessed the long-term patient reported mental wellbeing outcomes of post-operative CES patients. METHODS: Patients who underwent surgery for CES between August 2013 and November 2014 were identified using an ethically approved database. They then completed validated questionnaires over the telephone assessing their mental and physical functioning (Short-Form 12 Questionnaire), generating the Physical Component Summary (PCS) and Mental Component Summary (MCS). Bladder, bowel and sexual function were also assessed using validated questionnaires. MCS scores were compared to both the Scottish mean and previously published cut-offs indicating patients at risk of depression. Correlations of MCS with bladder, bowel, sexual and physical dysfunction were examined and multifactorial regression to predict MCS from these variables analysed. Independent t-tests assessed the mean difference in MCS between patients presenting with incomplete CES (CES-I) and CES with retention (CES-R) and between those with radiologically confirmed and impending CES. RESULTS: Forty-six participants with a mean follow-up time of 43 months completed the study. The mean (±SD) MCS was 49 (±11.8) with 22% demonstrating poor mental health related quality of life in comparison to the Scottish mean. Overall, 37% had scores consistent with being at risk for depression with in the last 30 days, and 45% within the last 12 months. MCS was significantly correlated with Urinary Symptoms Profile (USP) score (-0.608), NBDS score (-0.556), ASEX score (-0.349) and PCS score (0.413) with worse bladder, bowel, sexual and physical dysfunction associated with worse MCS score. Multifactorial regression analysis demonstrated both urinary (USP score p = 0.031) and bowel function (NBDS score p = 0.009) to be significant predictive variables of mental health related quality of life. There were no significant mean differences in MCS between those presenting with CES-I and CES-R or those with radiologically complete and impending CES. DISCUSSION: This study demonstrates a high frequency of being at risk for depression in patients with CES and identifies outcome measures (physical, sexual and more so bladder and bowel dysfunction) associated with poorer mental wellbeing. Our large cohort and long follow-up highlight that CES patients should be considered at risk of depression, and the need to consider mental health outcomes following CES surgery

Secondary damage management of acute traumatic spinal cord injury in low and middle-income countries: A survey on a global scale (Part III)

In LMICs, several factor may affect the applicability of guidelines for secondary damage control of spinal cord injury.•In LMICs, the use of steroids for spinal cord injury is heterogeneous and admissions to an intensive care units are limited.•The delays for surgical decompression of spinal cord injury can be significan and vary across income and geographic region.•Transfer times seem to be the most common reason for surgical delay in all income and geographic regions.•Costs for surgery for spinal trauma may be a significant barrier to guideline adherence, especially in low-resource settings

Exploración de las perspectivas y el cumplimiento de las directrices para traumatismos de la columna vertebral en adultos en economías sanitarias de ingresos bajos y medios: Una encuesta sobre barreras y posibles soluciones (parte I)

• Most spinal trauma occurs in low- and middle-income countries (LMICs), but some elements may limit the application of current guidelines. • In LMICs, a respectable proportion of physicians treating spinal trauma is not aware of any guidelines on this topic. • Most physicians managing spinal trauma in LMICs believe that following the guidelines may positively affect patient outcomes. • Most believed they have the capability to apply, the guidelines, but variation according to income and geographical region exists. • The perceived limitations and their relevance to guideline adherence vary across different income and geographic areas worldwide. • Resource-targeted guidelines for spinal trauma are considered a valuable option to overcome the limitations of real-life application of the current guidelines

Concomitant trauma of brain and upper cervical spine: lessons in injury patterns and outcomes

Purpose: The literature on concomitant traumatic brain injury (TBI) and traumatic spinal injury is sparse and a few, if any, studies focus on concomitant TBI and associated upper cervical injury. The objective of this study was to fill this gap and to define demographics, patterns of injury, and clinical data of this specific population. Methods: Records of patients admitted at a single trauma centre with the main diagnosis of TBI and concomitant C0-C1-C2 injury (upper cervical spine) were identified and reviewed. Demographics, clinical, and radiological variables were analyzed and compared to those of patients with TBI and: (i) C3-C7 injury (lower cervical spine); (ii) any other part of the spine other than C1-C2 injury (non-upper cervical); (iii) T1-L5 injury (thoracolumbar). Results: 1545 patients were admitted with TBI and an associated C1-C2 injury was found in 22 (1.4%). The mean age was 64 years, and 54.5% were females. Females had a higher rate of concomitant upper cervical injury (p = 0.046 vs non-upper cervical; p = 0.050 vs thoracolumbar). Patients with an upper cervical injury were significantly older (p = 0.034 vs lower cervical; p = 0.030 vs non-upper cervical). Patients older than 55 years old had higher odds of an upper cervical injury when compared to the other groups (OR = 2.75). The main mechanism of trauma was road accidents (RAs) (10/22; 45.5%) All pedestrian injuries occurred in the upper cervical injured group (p = 0.015). ICU length of stay was longer for patients with an upper cervical injury (p = 0.018). Four patients died in the upper cervical injury group (18.2%), and no death occurred in other comparator groups (p = 0.003). Conclusions: The rate of concomitant cranial and upper cervical spine injury was 1.4%. Risk factors were female gender, age ≥ 55, and pedestrians. RAs were the most common mechanism of injury. There was an association between the upper cervical injury group and longer ICU stay as well as higher mortality rates. Increased understanding of the pattern of concomitant craniospinal injury can help guide comprehensive diagnosis, avoid missed injuries, and appropriate treatment