NIH Researchers Identify Key Factor that Stimulates Brain Cancer Cells to Spread, August 18, 2009 News Release – National Institutes of Health (NIH)

NIH Researchers Identify Key Factor that Stimulates Brain Cancer Cells to Spread, August 18, 2009 News Release – National Institutes of Health (NIH)

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Scientists on Twitter – Astronomers, Biologists, and Chemists, and more – Science Pond

thanks to scienceroll this is a good page to scientists on Twitter.

Scientists on Twitter – Astronomers, Biologists, and Chemists, and more – Science Pond

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BMJ Group blogs

interesting blogs to follow when time allows to enjoy some readings

BMJ Group blogs

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HPA – Trichloroethylene – Health Effects of Chronic / Repeated Exposure (Human)

Trichloroethylene is the first substance I’m dealing with in my studying of toxicology. I don’t intend to read a lot about occupational toxicology but to concentrate more on monitoring of the important drugs used in therapy.

HPA – Trichloroethylene – Health Effects of Chronic / Repeated Exposure (Human)

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Why don’t medical students have to learn about health care policy? – By Christopher Beam – Slate Magazine

I recall we studied a lot about the Italian health care system while doing the subject of “Hygiene and pubblic health”. One thing I remember that it was established two days before Christmas on that year. I thought it was presented as a gift to the population.

Why don’t medical students have to learn about health care policy? – By Christopher Beam – Slate Magazine

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Popular Stop-Smoking Drugs to Carry Mental Health Risk Warnings

The FDA said it will immediately require boxed warnings about the risk of serious neuropsychiatric symptoms on the packaging of two popular smoking cessation drugs, — varenicline (Chantix) and bupropion (Zyban, Wellbutrin, and generics).

First I read this from KevinMd site. Then from the medpage site. See the link below. To think that these drugs is said has been very effective in helping smokers to quit. I should go to read about their mechanisms of action but i recall the importance of Nucleus acumbens, situated at the base of the bran, in developing reward.

Popular Stop-Smoking Drugs to Carry Mental Health Risk Warnings

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Everything depends on everything else

REVIEW, Clinical Microbiology and Infection, Vol: 15, Issue: s1

January 2009

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Abstract: In physics the concept of entanglement is well established and it has become increasingly apparent that all levels of biological organization (communities, organisms, cells, metabolism) consist of mosaics of interactive networks. There is a universe of bioactive microbial chemicals that have so far only been considered for their therapeutic applications; for example, the environmental roles of antibiotics have been little investigated. At sub-inhibitory concentrations, so-called antibiotics have been shown to modulate bacterial functions in subtle ways; they behave more like signals than toxins. It is proposed that networks of microbial cell signalling are primarily based on the interactions of low molecular weight compounds with macromolecular receptors; studies of the nature of these signals will reveal important information on the functions of microbial communities.

This is an interested article

Xanthopsia and the distribution of Jaundice in body fluids

What is it, xanthopsia?

In deep jaundice, the ocular fluids are yellow, and this
is considered to explain the extremely rare symptom of
xanthopsia (seeing yellow).

The wikipedia definition is here:

“Xanthopsia refers to the predominance of yellow in vision due to a yellowing of the optic media of the eye. The most common cause is digoxin toxicity and the development of cataracts which can cause a yellow filtering effect”.

The General Practice notebook definition :

The patient with xanthopsia complains that his vision has a yellow tinge.

Xanthopsia is caused by:

• severe jaundice
• digoxin toxicity.

I’m reviewing now the liver diagnostic tests and procedures and have posted about in a previous post. The metabolism of bilirubin and its secretion by the liver is one of the important subjects related to the liver function and testing. I’m reading important notes about bilirubin metabolism and how jaundice is distributed in body fluids. One is the term xanthopsia which in wikipedia is associated with cataracts and digoxin toxicity but not with deep jaundice. Another notes about the distribution of jaundice is that exudate tends to be more icteric than transudates because it contains more protein-bound bilirubin; that urine, sweat, semen and milk contain bile pigment in the deeply jaundiced patient. But most importantly is the fact that bilirubin is readily bound to elastic tissue. Skin, ocular sclera and blood vessels have a high elastic tissue content, and easily become icteric. This also accounts for the disparity between the depth of skin jaundice and
serum bilirubin levels during recovery from hepatitis and cholestasis.

I’m reading on this outstanding textbook of liver diseases, but only few things as it is too much vast:

Diseases of the Liver

and Biliary System by SHEILA SHERLOCK and JAMES DOOLEY

Neuroscience

From the educational site of Prof. Eric Chudler and from his newsletter here is the “the site of the month” selected by him:

The LUMEN Cross-Section Tutorial web site was created by Dr. John A. McNulty (a professor of Cell Biology, Neurobiology and Anatomy at Loyola University) using images from the Visible Human Project.  The Web site consists of images of slices from the human body from the head to the foot.

Of particular importance to people interested in the brain are the
photographs, magnetic resonance images (MRI) and computed tomography (CT) scans for the head and neck.  To see these images, enter the site and
click on “Head & Neck.”  This will bring you to a page with a photograph
with various lines attached to boxes labeled “Image” – “MRI” – “CT.” When you click on one of the boxes, the right side of your display will
show a cross section (either a photograph, MRI or CT) at the level of the
line.

Each of the cross sections show many numbered lines pointing to various
structures.  If you click on one of the numbers, the name of the structure
will be displayed in the upper left side of your monitor.  Try to guess
the name of the structure before you click on a number!  It’s a fun way to
learn your way around the brain.

Thanks to Prof. ERIC CHUDLER

Macroenzymes

Macroenzymes, what are they?

“Macroenzymes are enzymes in plasma that have a higher molecular mass than the corresponding enzyme normally present under (patho) physiological conditions. They may arise through self-polymerization or by association with other plasma components, in particular immunoglobulins”.

This citation from an article:

“A paediatric case of macro aspartate aminotransferase”

Read the article here doi:10.1258/acb.2007.007094 Ann Clin Biochem 2008;45:323-324

Why I’m interested? I encountered this subject during studying for liver function tests after having finished the disorderds of lipid metabolism which I posted about below.

Type-1 macroenzymes result from the formation of antigen-antibody complexes, using GPT, GOT, gama-GT, and AP

Type-2 macroenzymes result from oligomerization using gama-GT, AP, LAP and 5′-NU.

In the absence of clinical findings continuous elevation of measured GPT(and also GOT) is found with the appearance of macroenzymes.

Disorders of lipid metabolism

Or disorders of lipoprotein metabolism. I studied for this subject some chapters from important textbooks of medicine:

1. Chapter 350 from the Harrison’s principles of internal medicine. Clinically is the most comprehensive on the subject, either the description of  diseases of lipid metabolism or the approach to treatment.

2. Chapter 217 from Cecil medicine. Same as the above particularly when telling the physiopathology and the role of nuclear factors such as the PPARalpha, PPAR?, and PPARd in the regulation of lipids in the human body.

3. Chapter 21 “hyperlipidemias” from the Lippincott’s illustrated reviews: pharmacology 4th ed. a good rapid and concise review on the drugs used here.

4. Chapter 5 Tests of lipid metabolism from the Wallach interpretation of diagnostic tests. Excellent tables on this subject from the Adult Treatment Panel III guidelines.

One of the most useful paragraphs on the subject is that where the Harrison’s describes the diagnostic process. Now I should consider the lab results and divide them in categories. The critical first step in managing a lipid disorder is to determine the class or classes of lipoproteins that are increased or decreased in the patient. I might have Lab results showing only increased levels of tryglicerides or only increased levels of LDL-cholesterol and think about the differential diagnosis in each situation. But the most common error in the diagnosis and treatment of lipid disorders occurs in patients with a mixed hyperlipidemia without chylomicronemia. This occurs with increased levels of both cholesterol and tryglyceride which may indicate TypeIII (increased IDL levels) or Type IIb( increased LDL and VLDL) or TypeIV ( increased VLDL levels). Analysis of lab tests is very important to distinguish between the different situations. I also considered the secondary causes of lipid disorders: obesity, Diabetes mellitus, thyroid diseases, renal diseases, liver disorders, alcohol, and endocrine disorders but particularly the role of hyperlipidemia as a major risk for Coronary heart disease. Actually the tests of lipid metabolism ( my initial interest in this subject) has two important objectives:

1. to assess risk of atherosclerosis, especially Coronary heart disease

2. to classify hyperlipidemias.

I reviewed all the other risk factors for coronary heart disease(CHD) and understood the importance in calculating the atherogenic risk in a general practice setting. What I’m doing is to try to build the good and necessary clinical knowledge (CK) that one needs.

Variability is the law of life

Sir William Osler said, “Variability is the law of life, and as no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease.”

This statement is cited in the article about the new , precise definition of acute myocardial infarction which I already posted below. The authors Shaun Senter MD and Gary S. Francis MD describe the wide variety of presentation of myocardial infarction and explain the need to make precise diagnosis before taking action. I read the article and learned new things in this subject. When studying a certain condition on my textbooks I try to keep in mind the most important clinical features that describe it and make a single picture of the disease but I should also be aware to the variability of presentation of a pathological condition. It might be that this variability depends on the extent to which tissues and organs are involved in a certain disease  or to the way a patient’s organism responds depending on their age, sex or other factors; I’m not sure but this what I think could be. The autors review the current criteria that is established by international cardiovascular societies for making diagnosis of MI:

“The cornerstone of diagnosis remains a high level of clinical suspicion, serial ECGs, and troponine” they say. Particulary the focus on the role of troponine. There is also a clinical classification of MI in five different types.

Read the article here.

Recently I studied some chapters on the Jacques Wallach Interpretation of diagnostic tests, 8th ed and I found very good tables for the interpretation  of biomarkers in this context, one about the characteristics of serum markers for MI is this :

Early appearance: Myoglobin, CK isoforms, glycogen phosphorylase isoenzyme BB, heart fatty acid-binding protein
High specificity: cTnI, cTnT, CK-MB, CK isoforms
Wide diagnostic window: cTnT, cTnI, LD, myosin hight and heavy chains
Risk stratification: cTnT, cTnI, CK-MB
Predicts reperfusion: Myoglobin, cTnI, cTnT, CK isoforms
Indicates reinfarction after 2–4 d: CK-MB

The Wallach’s textbook confirm the possibility of false-positive ECG in >10% to 20% of AMI cases in the ED and nondiagnostic in about 50%. But here there is an additional note about newer biomarkers being studied as independent predictors of cardiac risk which I did not know before such as The ischemia-modified albumin and others.

I’d like, here below, to summarize  only the clinical features of MI which describe the clinical variability of the condition cited in the article  above:

.

• the presentation of myocardial infarction varies from 25% of patients with no symptoms to patients with severe, crushing chest pain.
• Discomfort may occur in the upper back, neck, jaw, teeth, arms, wrist, and epigastrium and it build up in a crescendo manner. It can lessen in the standing position. A pressure sensation, air hunger, or gas “building up” can be described.
• Shortness of breath, diaphoresis, nausea, vomiting and even syncope may occur.
• The only symptoms may be shortness of breath and diaphoresis
• symptoms last from minutes to hours and can be releived by sublingual nitroglycerin.
• Atypical presentaion or less prominent symptoms may make the diagnosis difficult in the elderly and in patients with diabetes, and in women.
• On physical exam the patient may appear pale and diaphoretic and the skin cool. Heart sounds are soft and a fourth heart sound may be audible. BP may be low and tachycardia and pulmonary edema are poor diagnostic features.

Prealbumin (PAB)

First it was established that to assess the nutritional status of a critically ill patient admitted to the ICU or to surgery it was necessary to determine albumin, prealbumin, C -reactive protein and retinol-binding protein. Prealbumin is considered the better choice for this purpose, why?

Albumin has a half-life of 21 days, it is slow to respond to changes while PAB has a half-life of 2 days and respond quickly to any change in the nutritional status of the patients.

Reference values:

Values of 0 to 5, 5 to 10 and 10 to 15 mg/dL indicate severe, moderate and mild protein depletion respectively.

Moreover, I understand that PAB is used to determine in a traumatic patient that the losing liquid from their nose is a cerebrospinal fluid (CSF) by the determination of the concentration of PAB in it.

I’m studying some chapters in lab medicine and diagnostic testing.

Sir william Osler- Quotes

When our physician forebear Sir William Osier (1849-1919) was asked what
his most important contribution to medicine was, Osler stated simply:

“I desire no other epitaph . . . than the statement that I taught medical students
on the wards, as I regard this as by far the most useful and important work
I have been called upon to do” (Osler, 1905).

In using the term student, Osler generally was referring to all trainees in medicine—interns and residents as
well as students. They were all his junior colleagues, as he described them.

I picked up this quote from the introduction of the book : Resident’s teaching skills by Janine Edward.

Primary Prevention Of Atherosclerotic Heart Disease: New Data from the AHA

Thanks to KevinMd where I got information about reachMd radio. Actually it is a good educational site, there are many prog to follow and I just finished my first act of listening to an interesting program on the primary prevention of atherosclerotic heart disease and got a CME 0.25 credit. As only a medical student I only wanted to listen and develop a little my english and also get new important information directed to general practice. The clinical researcher discussed in this activity the results of a trial  in which patients with a normal level of cholesterol= 130mg/dL but with high levels of C reactive protein called CRP (which is considered an important risk factor for CAD) took a statin to prevent the occurence of cardiac events. The trial resulted in a 44% reduction in cardiovascular events and was stopped early because the benefits were very evident.   

Listen here.

A new, precise definition of acute myocardial infarction

This article from the Cleveland clinic journal of medicine discusses very important issues in the diagnosis and differential diagnosis of Myocardial infarction.

Read the article here

“Several international cardiovascular societies have revised their diagnostic criteria for acute myocardial infarction (MI) (J Am Coll Cardiol 2007; 50:2173–2188). The cornerstone of diagnosis remains a high level of clinical suspicion, serial electrocardiograms, and troponin levels. This article reviews the new definition and the appropriate clinical tools necessary to diagnose acute MI accurately”

KEY POINTS The clinical presentation of acute MI varies considerably from patient to patient. Therefore, one must consider the symptoms, serial electrocardiographic findings, and serial biomarker results in concert.

KEY POINTS Troponin I or T is now the preferred biomarker of myocardial necrosis. Still, troponin can be elevated in many conditions other than ischemic heart disease.

KEY POINTS Electrocardiographic signs of acute ischemia have been precisely defined, but electrocardiography can give false-positive or false-negative results in a number of conditions.

KEY POINTS MI is now categorized into five types depending on cause.

Hepatology 2009 from Bernard Sebastian Kamps

From Bernd Sebastian Kamps

A new book on Hepatology in  free PDF , here is the textbook.

The textbook includes 300 pages about viral hepatitis and two chapters about
the management of HBV/HIV and HCV/HIV coinfection.

Hepatology 2009
A clinical textbook
501 pages
ISBN: 978-3-924774-63-9

Risks of proton-pump inhibitors: what every doctor should know

This is an interesting editorial introduces an article on the Medical Journal of Australia:

Risks of proton-pump inhibitors: what every doctor should know

“A low level of gastric acid promotes the growth of swallowed and enteric flora in the proximal gut, and these bacteria may be aspirated during episodes of physiological reflux. In this issue of the Journal, Roughead and colleagues assess the risk of pneumonia in Australian veterans taking PPIs”

The article is here.

MJA 2009; 190 (3): 109-110

The bottom line is that no drug is completely safe, and this applies to acid suppression therapy. Fortunately, the risks, if causal, seem small, although preventive strategies are largely unavailable and identifying those at particularly high risk of serious side effects (eg, based on pharmacogenomics to individualise therapy) is not yet an established strategy. However, it is prudent and best practice to warn patients about the potential serious (albeit rare) side effects of PPIs, to prescribe the lowest possible dose of PPI (when indicated) for as short a time as possible, and to consider alternative management options if these are available.

When high is low: Raising low levels of high-density lipoprotein cholesterol

This is an interersting article to read on this subject, low levels of HDL-C as a risk factor for cardiovascular disease and how to raise them. Thanks to MDLinks.

Low serum levels of high-density lipoprotein cholesterol (HDL-C) are highly prevalent and are recognized as an independent risk factor for cardiovascular morbidity (myocardial infarction, stroke, peripheral arterial disease, and restenosis after coronary stenting) and mortality. HDL plays an important role in modulating atherogenesis, although its functions are varied and complex and the mechanisms for its antiatherogenic effects have not been completely elucidated. The inverse relationship between HDL-C and cardiovascular risk is well established, and epidemiologic studies and clinical trials have provided ample evidence that higher levels of HDL-C are vasculoprotective. Although considerable interest exists in the development of novel approaches to raise serum HDL-C and to augment HDL functionality, this article discusses currently available therapies to raise suboptimal levels of this important lipoprotein.

The article is cited:

Journal Title  – Current Cardiology Reports
Article Title  – When high is low: Raising low levels of high-density lipoprotein cholesterol
Volume  – Volume 10
Issue  – 6
First Page  – 488
Last Page  – 496
Issue Cover Date  – 2008-11-01

Author  – Peter P. Toth
DOI  – 10.1007/s11886-008-0077-2
Link  – http://www.metapress.com/content/b7xk865071252854

Students whose behaviour causes concern: Case history

I found this article from the British medical journal interesting as it concerns either medical student or medical professionals.

“What should you do when you see a fellow student behaving inappropriately? After a group of students wrote to the BMJ about their experience during an elective, we sought the opinions of an ethicist (doi:10.1136/bmj.a2882), a dean (doi:10.1136/bmj.a2884), a GMC representative (doi:10.1136/bmj.a2876), and a lecturer from an African university (doi:10.1136/bmj.a2875)”.

Concepts in Cardiovascular Physiology

From Cardiovascular Physiology by David  E. Mohrman:

“A common misconception in cardiovascular physiology is that the systolic pressure alone or the diastolic pressure alone indicates the status of a specific cardiovascular variable. For example, high diastolic pressure is often taken to indicate high total peripheral resistance. This is not necessarily so since high diastolic pressure can exist with normal (or even reduced) total peripheral resistance if heart rate and cardiac output are high. Both systolic pressure and diastolic pressure are influenced by heart rate, stroke volume, total peripheral resistance, and C_A ( compliance). The student should not attempt to interpret systolic and diastolic pressure values independently. Interpretation is much more straightforward when the focus is on mean arterial pressure:

P_A = CO x TPR and arterial pulse pressure: P_p= SV/C_A.”

I really always thought the diastolic pressure as indicator of the total peripheral resistances, which is a specific cardiovascular variable, without thinking about it in the way the author is explaining it in the above piece.

Some more concepts:

“Turbulent blood flow is abnormal and makes noise (murmurs and bruits)”.

(the normal blood flow is the laminar one)

“Veins contain most of the total blood volume”.

“Because arteries are elastic, the intermittent flow from the heart is converted to continuous flow through capillaries.”

“Mean systemic arterial pressure is determined by the product of cardiac output and total peripheral resistance.”

“Changes in arterial pulse pressure reflect changes in stroke volume and/or the compliance of the arterial space.”

I’m now going to review an another chapter in the same book: the “Vascular Control” and “the central venous pressure” which was my aim of reviewing.

Hypertension, December issue of “In The Clinic”

Annals of internal medicine has this very interesting and educational section directed to the physician in practice: “In The Clinics”. Since the beginning of 2007 they have published many important monthly issues. Each is accompanied with important tool kit that take the reader to many added resources:

“In the Clinic is a monthly feature in Annals of Internal Medicine introduced in January 2007 that focuses on practical management of patients with common clinical conditions. It offers evidence-based answers to frequently asked questions about screening, prevention, diagnosis, therapy, and patient education and provides physicians with tools to improve the quality of care.

The foundation for In the Clinic is the evidence-based clinical guidance in the American College of Physicians’ electronic point-of care decision-making resource, PIER (Physicians Information and Education Resource). In developing In the Clinic, Annals editors draw upon other ACP knowledge products, such as MKSAP (Medical Knowledge Self-Assessment Program), as well as outside resources, including practice guidelines and quality-of-care measures. In the Clinic integrates this material on broad topics in a relatively brief, easy-to-read format with an emphasis on practical measures that can be readily integrated into practice.”

This month’s issue is about HYPERTENSION.

Edema: why begins in the left leg

I’m reviewing signs and symptoms, differential diagnoses, methods of physical and history taking and these are some of my notes i encountered today:

The best method for determining the cause of an edema is to consider each of the pathophysiologic categories; there are four categories:

1. edema caused by INCREASED PERMEABILITY

2. edema caused by INCREASED INTRAVASCULAR PRESSURE.

3. edema caused by DECREASED ONCOTIC PRESSURE ( the intravascular).

3. edema caused by OBSTRUCTION OF LYMPHATIC DRAINAGE OF TISSUES.

There are good note or clues that help in the diagnosis of edema, some are :

“Increased permeability affects all tissue beds equally; edema of the upper and lower extremities (and face) suggests increased permeability as the etiology”.

“Increased intravascular pressure is due to either volume overload or an obstruction of venous blood to the heart. Because pressure is greatest in the lower extremities due to gravity, edema due to increased intravascular pressure always begins in the lower extremities and ascends superiorly to the site of the obstruction. Venous pressure is higher in the left leg because the left iliac vein must cross under the aorta to join the vena cava. Edema due to increased intravascular pressure almost always begins in the left leg, eventually involving both legs”.

Physical biology

the-preoccupations-of-twenty-first-century-biology-by-david-baltimore

This is a great book of science “Physical Biology ” by Nobel Laureate Ahmed Zewail:

“This is an avant-garde book edited by Nobel Laureate Ahmed Zewail with contributions from eminent scientists including four Nobel prize winners. The perspectives of these world leaders in physics, chemistry, and biology define potential new frontiers at the interface of disciplines and including physical, systems, and synthetic biology”.

I read the first two chapters of the book. Chapter 1 by David baltimore can be accessed free. The chapters are not reviews but overviews. In the first article by David Baltimore there is a wonderful description of the field of biomedical sciences today. How life science research changed in the millenium, how its methods are new and more available to scientists everywhere. The author ascertain the fact: ” Thus, there is a higher premium on innovative thinking, on the creative asking of questions”. I, now understand better also the glossary: Structural biology, systems biology, Synthetic biology and their different fields of research. All interesting to have a large open view of what science is facing and struggling to achieve gradually.

Physical Biology

Multitasking

I picked up this site of the month from neuroscience for kids.  It is related to multitasking:

“Do you work on your homework as you watch TV, listen to your IPod, and eat a snack.  You may think this “multitasking” is easy, but you would be mistaken.  Effective multitasking is difficult and the DualTask.org web site will prove it”.

This is here the site

as I know myself I don’t think to be good in multitasking; the worst time for me is when I don’t get good sleep for a long period of time.

Iron homeostasis: Fitting the puzzle pieces together

Cell Metabolism Volume 7 issue 4 9 april 2008 pages 288-290

PMID: 18396134 Put this in Pubmed to reach the article.

doi:10.1016/j.cmet.2008.03.008 .

A brief piece of the article:

“Here, recent insights into iron homeostasis are highlighted. Three studies demonstrate the importance of the IRE-IRP system for enterocytes in balancing extracellular iron demand against cellular iron requirements, show that the hemochromatosis protein HFE exerts its iron-regulatory activity principally in hepatocytes by modulating the production of hepcidin, and provide strong support for a proposed mechanism of transcriptional regulation of hepcidin through a signaling cascade initiated by holotransferrin displacing HFE from transferrin receptor 1.”

I finished reading the above article and after three times reading the text I now can assure I understood the pieces that make together the iron metabolism in our organisms. It is an interesting subject and I reached here while preparing for a material in medicine : ” lab tests and the interpretation of diagnostic tests”.

I searched for the word Hepcidin in the MeSH database of the Pubmed and I only found this definition:

“a urinary antimicrobial peptide synthesized in the liver; may play a role in the regulation of iron metabolism; amino acid sequence in first source
Date introduced: June 15, 2001”.

I will update this post in the next days with more definitions of my understandings in the subject.

Iron and human disease

doi:10.1371/journal.pbio.0000079

The above link to an interested primer on the importance of iron in human metabolism and disease

“How Mammals Acquire and Distribute Iron Needed for Oxygen-Based Metabolism”.

A link to the primer.

Blood & Guts: A Short History of Medicine

Blood & Guts: A Short History of Medicine by Roy Porter

I read the above book in my subject in human sciences in last July. I liked it. It is a wonderful writing of Roy Porter. The chapters are divided in issues, such as : Diseases, Doctors, The Human body, The lab, The Hospital etc… and it finishes in treating the history of the different medical systems in the Western countries. Reading such books and subjects give you more values and make your study and interest more interesting. Certainly I had to add the above book to some more material to achieve the subject “human sciences”, one of these was aslo the history of the different theories in Psychology.

A link to the book in the Barnes&Noble bookshop

Aphorisms

The medical art consists
in three things—the disease,
the patient, and the physician.
The physician is the servant
of the science, and the patient
must do what he can to fight
the disease with the assistance
of the physician.
Hippocratic Epidemics,

Gandhi’s talk

Read the Gandhi’s talk here .  Gandhi in the Wikipedia.

“his birthday, 2 October, is commemorated  world-wide as the International day of non-violence.”