Ahmet Aciduman

A randomised controlled trial of ribavirin in Crimean Congo haemorrhagic fever: ethical considerations

The randomised controlled trial (RCT) constitutes a quantitative, comparative, controlled study of a particular treatment, and provides invaluable evidence regarding its pharmacotherapeutic efficacy. These studies are generally predicated upon the ethical principle of clinical equipoise. However, this may be insufficient to justify withholding treatment from a control group while assessing drug therapy in a potentially fatal disease. Thus, the criteria for randomisation, informed consent methodology and timing, and consideration of treatment options in such a scenario remain the province of medical ethics. This paper addresses the need for an RCT of ribavirin in the treatment of Crimean Congo haemorrhagic fever, and highlights underlying ethical concerns in light of the current medical, virological and ethical literature.

Management of Spinal Disorders and Trauma in Avicenna's Canon of Medicine

WE STUDY HISTORY in an attempt to achieve a wide perspective of life and reality. Spinal disorders, particularly spine traumas and their complications, have been one of the most challenging problems throughout the history of medicine and, indeed, throughout the history of humanity. The pioneers and founders of scientific medicine committed much of their lives to understanding these disorders. There is a paucity of historical documentation. From the extraordinary efforts of early practitioners, we may glean insight relevant to the more effective treatment of such debilitating disorders. Ibn Sina (Avicenna), who lived in the medieval period, was one such physician. His principal book of medicine, The Canon, played a fundamental role in the practice of medicine in the Eastern and Western worlds between the 11th and 17th centuries. In this book, published in the 11th century, he provided detailed accounts of spinal disorders and strategies for their management. Here, we provide a brief review of Avicenna’s most significant points concerning spinal diseases and their treatment from the chapters of the Canon. Although, there are not basic differences from Hippocratic knowledge, this book contains some original contributions.

Peripheral nerve disorders and treatment strategies according to Avicenna in his medical treatise, Canon of medicine.

The written transmission of knowledge has played a great part in the advancement of medicine, and historical documents hold the key to a full exploration of the history of medicine. Some fields, including disciplines that deal with peripheral nerve disorders, have received little benefit from such valuable material. In particular, peripheral nerve surgery lacks perspectives from historical data. For many years, physicians have obtained positive results in the surgical treatment of peripheral nerve diseases. Relevant documents reveal that the first author who described the surgical repair of damaged peripheral nerves was Avicenna, a leading figure of the medieval era who lived in the Middle East. In his primary medical work, the Canon, he provides a description, albeit sketchy, of a suture procedure for peripheral nerve transection. This treatise influenced physicians for several centuries. In this presentation, we analyze excerpts from the Canon that concern peripheral nerve disorders and strategies for their management.

What does Al-Qanun Fi Al-Tibb (The Canon of Medicine) say on head injuries?

A historical approach could help in the detection of some viewpoints that cannot be paid attention to or signified by a purely medical one. In this text, the important points of Ibn Sina’s (Avicenna) treatise on head injuries have been introduced in light of neurosurgery. The most detailed chapter regarding head injuries in Canon, under the title of “Fracture of the Skull,” presents rather detailed knowledge concerning skull fractures and their surgical treatments in the eleventh century and the medical paradigm of that era. Ibn Sina provided extremely systematic knowledge on head traumas along with both his observations and experiences and citations from the writings of the ancient physicians, Galen and Paul of Aegina. Regarding the treatment of skull fractures, Ibn Sina is a real successor of Galen and Paul of Aegina.

Hydrocephalus and its treatment according to Rhazes

The renowned medieval Persian physician Rhazes was an early proponent of experimental medicine. Rhazes made fundamental and enduring contributions to medicine and to other scientific fields. He wrote over 200 scientific books, more than half of which concerned medicine. He was well versed in Persian, Greek, and Indian medical knowledge, and made numerous contributions to the medical field through his own observations and discoveries. He was also a pioneer in the field of neurosurgery and, as he was predominantly a pediatrician, he dealt with the subject of hydrocephalus. A large part of his medical tome, al-Hawi, deals with head-related disorders including the hydrocephalus. Although he did not introduce novel concepts of hydrocephalus and its management, by combining the different approaches of experienced scholars he endeavored to improve treatment and knowledge of this problematic disease.

Account of Haly Abbas regarding the management of hydrocephalus in children: a text from medieval times.

OBJECTIVE To present the text on hydrocephalus from Haly Abbass book Kitāb al-Malikī / Liber Regius (The Royal Book), which was accepted as a classical textbook in the Eastern and Western worlds for a long time. METHODS The Arabic (Süleymaniye Manuscript Library, Murad Molla Collection, Nr: 1482 and Būlāḳ, 1294 /1877) and the Latin (Venice, 1492) versions of the related chapter was translated and compared to create an English text. Additionally, relevant literature was reviewed in detail. RESULTS The text on hydrocephalus in Haly Abbass The Royal Book virtually resembles Paul of Aeginas work. For hydrocephalic cases where the fluid collects between skin and pericranium, and pericranium and bone, Haly Abbas had made little change in surgical intervention; for the third type, skin incision, he preferred a T-type incision instead of an H-type. Like Paul of Aegina, Haly Abbas also did not advise any surgical intervention for the cases of hydrocephalus, where fluid accumulation is between bone and the dura mater. CONCLUSIONS Haly Abbass approach to hydrocephalus was as brave as that of his predecessors Antyllus, Oribasius, and Paulus, although the cases they dealt with were almost all cephalic hematomas. Although his chapter on the treatment of water accumulation in the head contains surgical interventions in extracranial hydrocephalic conditions, his account on hydrocephalus is extremely precise and gives adequate detail as in other chapters in his book.

An Evaluation Regarding the Current Situation of Stem Cell Studies in Turkey

Turkey is in a parallel state to that of other countries for developments in stem cell research and practices. Nevertheless, Turkish law has no regulations for stem cell practices. To define a legal framework for stem cell research, rules of general content should be used as the starting point. In 2005 and 2006, a general regulation and guidelines on stem cell research were published by Turkish Ministry of Health. Thus, the ministry, based on this first general regulation, stopped “Embryonic Stem Cell Research”, while allowing “Adult Stem Cell Research” by a second general regulation. The method of such research was regulated with the addendum of ‘Guidelines for Clinical Research on Non-embryonic stem Cell’. With the latest regulation, clinical stem cell research in Turkey has been based on ‘Regulations for Clinical Research’, which was legislated in 2009. However, the aforementioned regulations by the ministry are still legally binding. In addition, other regulations such as Medical Deontology Regulations of 1960 and Patients’ Rights Regulations of 1998 are to be consulted for stem cell research in Turkey. While it is especially important that research that is still at experimental level not provide an opportunity for trade of hope in patients and their relatives, ethics discussions are enlightening in developing regulations and critical evaluation of current practices.

Neuroethics and Neurolaw in Turkey

This section is dedicated to examining the subject “Neuroethics and Neurolaw in Turkey”. The development of medicine and related branches in Turkey generally demonstrates a parallelism with the examples from the similar countries in the world. In brief, the contemporary criterions are applicable to both education and daily practices of these fields. In this context, the headlines under the disciplines of neurology and neurosurgery shall be evaluated from the medical ethics and medical law points of view under the heading of scientific neurothics and neurolaws. Today, the worthiness problems related with the end of life constitute one of the most important subjects of discussion in medical ethics. In the neurology area, where this problem frequently arises, the commands: do not apply euthanasia and do not resuscitate are two important phenomena to be studied closely. A very crucial subject from the organ transplantation point of view is making the decision on the “brain death”. The specialists on neurosurgery and neurology in Turkey are legally tasked among the decision-making doctors in this subject. Therefore, this is one of the headings that will be discussed in the text from both ethical and deontological or medical law points of view. Thus, referring to an eternal problem of medicine “terminating a life” and also to a new concept the organ trade, belonging to the 21st century and which is the result of modern economical and political factors. The “clinical researches” shall be discussed as a rather discrete dimension of the daily doctor – patient relations under the heading of neurological sciences as a separate subsection within the text. Here, we shall discuss how the concept of informed consent may be applied to the patient and subject groups which the neurological sciences deal with in the normal daily medical applications and in research phases and the potential problems related with it. Another concept to be scrutinized here is how experimental treatments may be turned out to be a subject of hope trade in some communities. Finally, this section is a response given from a geography on the junction of Asia and Europe to the query of how different nations may develop different approaches to similar subjects from a “neuroethics and neurolaw” point of view.