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SI Digital Innovations in Learning is pleased to present
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The Jorge Lazarus Lecture Series on the origin and development of ideas in the clinical neurosciences. This course series consists of seven one-hour lectures with discussion
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The speaker will be Jorge Lazarev, Emeritus Professor of Neurosurgery, Department of Neurosurgery, Ronald Reagan, UCLA Medical Center, Los Angeles, California, USA Thank
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you.
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This is Dr. Lazarus introductory comments to his lecture series, and we quote, The most significant number of patients with diseases of the central nervous system live in low and middle income
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countries for no other reason than the majority of people are living in low and middle income countries.
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Let's start over.
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This is Dr. Lazarus' introductory comments to his lecture series, and we quote,
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The most significant number of patients with diseases of the central nervous system live in low and middle-income countries for no other reason than the majority of people are living in low and
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middle-income countries Nonetheless, neurosurgeons and neurologists from high-income countries offer most research papers on clinical neurosciences.
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This disparity is prejudicial to the neurosciences as a whole.
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We designed the course as an introduction to some of the tools that promote the genesis and development of research ideas
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This series of lectures are provided for you to bring the advances in clinical and basic neuroscience to physicians and patients everywhere.
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One out of every five people in the world suffer from a neurologically related disease.
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Lecture
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two, epistemology,
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is a tool for developing research ideas
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Hello everyone, I am Moshakkar, a medical student. Our first original developmental of ideas in the clinical neuroscience. The total number of their registered participants is 127. This includes
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95 medical students, 24 graduate and 7 young surgery Hang on, we are a surgeon.
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So, yes, we're done. Jordan, Lebanon, on Kuwait. Roman, Yemen, Arabic, Italy, on Yemen. The team will be me on my two
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friends, Summer, under a car, and will be heavy to answer your questions. Now, Dr. Lazar,
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Professor Lazar, we'll start in the presentation. Thank you. Thank you, Noah Well, two series of conversations about this is one. The first lecture I will record it again between today and
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tomorrow, and some filming in there, and we'll be safe and uploaded. Similarly with this lecture, if we see today that there are needs and needs, people coming back and forth and admitting and
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becomes hard to. to follow, then we will
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record it again, and both things will be uploaded in a site for you to access both and all the lectures of the series. Similarly, you received the PDF of last week lectures with some notes, you
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received the PDF of these lectures of today without notes, it is for you to to write whatever you you may be inspired to to annotate on that, but still we will have the recorded of this lecture and
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still you will have a writing explanation of the concept of the of the images.
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I said that to the Participants who were just now, and I repeat to those coming now, is don't be shy and write me. If you have a question, I did an address, you need a clarification. I gladly
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answer. I'm not judging anybody. I'm for me, the simple fact that you are here, that speaks enormously of your commitment and achievement. So if you think that you are asking a stupid question,
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you are not asking a smart question. There is no such a thing as a stupid question. All questions are basically smart. I made a, I juggled one or two of the slides of the series from the PDF that
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you received at one Minor changes that does not affect the content of what you are. what you have now in your PDF file, let's say. So, with that set, let's go to the subject. To repeat, for
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those who were last year, last Friday, and to introduce to the newcomers, the objective of this is to, is not written there, the objective of this is to have a vigorous
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clinical research, neuroscience program from your country and from all the Arab countries.
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The objective of this is that the wealth of information that is walking in front of you is not lost. The objective of this is to share with the world the immense number.
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or the immense volume of clinical experience that you have. And yes, provides some of the concepts necessary for clinical research, not just clinical research, but good clinical research. Yes,
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there are some clinical research that are not very good. I will, at the last lecture, we will pick up some of the papers without putting the name of the authors. And you will see, yeah, they
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were published, but man, who cares what they wrote, no? And in this literature series, we'll talk about a neglected
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factor when people teach us research, which is the idea. And what the idea comes? Who comes with the idea? What is that? What the idea? You just open a door, and there is an idea there, or you
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have to be German or American to have ideas? No, it's not the fact.
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And the guiding presentation of the genesis of the idea for a research project, you know, is similar, but not identically to diagnosis, you see, ideas in neuroscience don't come spontaneously out
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of nothing, nobody ever said I imagine a condition where the descent of the cerebellar tones is causes of cipital headache, no, no, you see somebody and they say why does somebody has that
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something. And then you come with the idea or the concept of carry disease, no.
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And to excel as a researcher, you need to be a great clinician
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Because it is in the patient, either in the direct manifestation of the body or any of the diagnostic tools where you find the seeds of a research idea
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Furthermore, I go to that, I will give 500 dollars on my own funds to anybody who tells me about a clinical idea that didn't start in a patient,
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all the clinical ideas, all every one clinical idea from the beginning of time, even Sena, Hippocrates, I don't know,
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all the clinical ideas start with a patient, they don't start in a laboratory or they don't start in anywhere else, they start with a patient, the500 offer is open. So, last Friday, we have this
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image, right? This is the slide I have it. Okay, the one on the left, you say, well, that's a soccer, the one on the right, those who were last Friday, remember, yeah, that's a game called
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Pato, P-A-T-O, who is played in South America, particularly Argentina, maybe a little bit in
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You know that because you were in the lecture last Friday, but those who came or missed the part of the lecture, they don't know what it is. Well, that is the same
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process that we do constantly with anything. And you will see how this is related to research and two clinical ideas, because the tools for reasoning were facing any situation are either induction
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or deduction.
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Furthermore, as you can see there on the top on the right, we have a cerebral representation for those ways of approaching or for those ways of thinking It's not just a thing that Lassarith decided
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to. come out with this concept, no, it's been proven, is there, is the foundation of knowledge. You know knowledge through experience and you either see something and recognize it or you don't
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recognize something and you start doing the deduction, right? So those two systems are the induction and the reduction. Inversion is deliberation without attention That's what you need with the
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soccer, immediately you raise the hand, oh, that's soccer. You just boom, have to look at the thing and then say, that's soccer. Is heuristic and biased? It is biased. Yeah. I mean, well,
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soccer is the world game, but somebody from, if I would have put cricket and Pato, then cricket maybe, some more people who are more familiar with cricket from the british culture also. India,
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Pakistan, I don't know, they would, they are, they had sell at cricket. And it's a gestalt effect. You see the whole thing. You only saw on the image the half of a goal. Somebody on a green
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shirt who you assume is the goalie. Could that be a spectator who just walking there, but you assume was the goalie. Right. And you saw three or four guys with different shirts looking So you have
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a guest. Oh, that's a, that is soccer. That is the whole stadium. You imagine the whole stadium around. But of course, induction has fallacies. One is semantic. Right. Not being clear in
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what you say. If you go to South America and you say soccer, people say, what are you talking about? What is soccer? No, it's his football
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Omission, information, calcium, aluminum, those fallacies. will be applied in some research, examples that we will have. I believe this is the last of the boring letters. I have two boring
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letters and then we'll have the other four or five more, more amusing. Or when you look at the Pato, you look at the other game that you don't know what the game is, you start doing a normative
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reasoning. You use modus pollens, modus pollens, we may talk about those. But you exhaust all the strategy, all the thinking strategy. You say, okay, this is a game placed, played by on horse,
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by riders, to teams. You look at the thing and you look at it as a ball that is with a handle. Then with those elements, you feed the computer, you go to Google, feed the computer and come with
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ideas.
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And Google can have some images similar and then you start looking whether they are similar or not. And your decision is robust. It's absolutely, it is perfect, no? So that is the way that we
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think, within, within that chain or with the that chain. We know or we don't know. And if we don't know, we start reasoning No, it's not that if we know, if we think, we know
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Um,
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And the patient, as I said before, and I repeat, for those who just arrived,
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the500 challenge, if anybody shows me a clinical result whose idea didn't start with a patient, I give you a check of500. And
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as I don't have500, I am absolutely sure that nobody will come
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I can offer anything because I guarantee there is no such a thing. But your approach to the patient, you tell you say, okay, this is the guy or the individual who is the origin of the idea in
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clinical neurosciences or in clinical research This is the, so you have, you approach that individual, when the individual opens the door or you walk into the, into the ward, you approach it
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informed by science, guided by reason unmotivated by compassion. or motivated by compassion informed by sign, guide by reason, or guide by reason motivated by compassion informed by signs. All
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the three things are together, right?
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You have some, even the most colors of the daughters have some compassion for that fellow human being who needs our help, who's asking for your help. That's the only reason the patient is there is
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for you to help or help. And then you are informed by signs, the other reason motivated by compassion. Last week, we said that science is not accumulation of knowledge. Science is a way of
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thinking. And the way of thinking is being able to answer questions that can be
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answered with a yes or a no. OK. So your tools for clinical diagnosis the same tools as you face when you look at the picture of the soccer and the pato
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are the same tools when you land in Beijing.
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All the signs are in Chinese, but you start figuring out which way to follow to go to custom. I don't know, or you land in Germany.
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And I don't speak German, but although some of the signs are in English, but there are people from Central America who don't speak English, who don't speak German, people from Nicaragua, they fly
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to Berlin and they land in there and they figure it out,
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either by induction or by deduction. And so the same tools, because you have only two sides on your brain, the same tools that you apply for the pato and You apply when you see a patient.
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And this is for, for example, the image on the top. Dr. Hoss, Professor Hoss, didn't have to think about it. He knows what it is. The second image,
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the boy with the eye, if you show this image, and I did that, I showed this image, which I downloaded from the web, incidentally Yeah, I showed this image to, when I gave this talk to some
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European students, and they came with the idea of being
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allergy to the pillow.
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The boy is sleeping on that side, allergy to the detergent of the pillow, you show this idea, this image, on anybody from Peru south.
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Anybody from Peru, Chile, Bolivia, Uruguay, Argentina, Brazil, and Paraguay. And they will tell you that's Chaga's disease.
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That boy has Chaga's. And the Swedish guy or the European guy will actually tell you of how the allergy to the detergent goes into the conundiva, and the hemucosa, and swells, and because of the
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sense The guy from Argentina will actually tell you no. The insect bites you at night when you're sleeping. You scratch. It defecates the parasite. You scratch
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your hand while you're sleeping. And in the morning was the first thing you do, you wrap your eyes, right? You wrap your eyes, and you transfer the bacteria to the scene but two different things.
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And the other image below that is a prep of leukemia,
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myelocytic leukemia. If any of you just did pathology knows that,
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those who didn't didn't, the one below. What do you see? You see a pupil larger than the other one
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Those who are very interested in neurosciences in neurosurgery will say, Ah yeah, that's a
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mediative pupil by damage to the third nerve. And
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that child may have a
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sedural or a, yeah, it's a neural nematoma, most likely or a temporal tumor, that's greatly But
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you saw the mediative pupil, maybe it's a meiotic pupil on the other side, maybe the the pupil on the right. is a normal size because it's dark, and the pupil on the left side is the one not
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expanding.
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And the same now with the electro-categories. We all know how many of us are here, I don't know how many we are now,
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somewhere 70 something, 70 students or the 1770 participants of this course, Professor Haus and myself know that's an electro-cariorum.
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But who can read that electro-cariorum? Well, very few, you have to start thinking. So that the process is the same. You see the patient, do recognize it, do not recognize it.
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Knowledge, critical thinking, inductive, deductive, and you start doing intuitive analysis is then going back and forth, back and forth. checking, counter-checking until you finally reach the
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diagnosis. That's the imprint in your brain. That's how we humans
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have the capacity to do. I've shown you the MRIs of that functional MRI, right? In that tip, the lab tip, that's what we do. That's what you will do when you graduate. And those who are
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graduated, that's what you do when you do clinical medicine. But that's not clinical research. We're going there.
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So, again,
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you have from Prohersi, this is I'm emphasizing just to bring the subject to really sediment the subject so I don't have to go back and bore you third and fourth time You have a type 1 process, you
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have a type 2 process. You have a pattern recognition. You have an analytical or adaptive, right? That is exhausting, robust, normative reasoning is what we call medicine-based in evidence.
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What is evidence? Well, evidence is there. It's like,
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that's what you have to do. You have to, if you have acute bleeding for an aneurysm, ideally you have to operate it in the first 48 or 72 hours I don't remember it shortly and the professor will
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know it better, but that's part of the gun. You have a patient with a myeloma ningussele, you have to operate it between in the first 24 or 48 hours, if not before the risk of infection increases
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and roll on. And the inductive deliberation without attention, which again is what you did when you looked so good and you raise your hand, it says ochre.
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Recognition, primate, get start effect. Well, we went through that. I'm not going to emphasize. So we have those two ways of thinking, inductive, the darkness. Okay. So far, Laserev told us
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how to do good clinical research. What about, no, tell us how to do good clinical diagnosis. Forget about clinical research We are here to learn about the ideas. And Laserev so far is not talking
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about the ideas, talking about something else. So how will reason ask clinicians?
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Through induction and through the reduction.
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The fantastic clinician that you know be it a neurosurgeon or a general surgeon or an internist or an ophthalmologist Are those guys who are able to.
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balance with us, but how we reason as clinical researchers,
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as clinical researchers, we reason through abduction.
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And in that turn, the abduction, abduction are the only three ways that exist in logic, in the science of logic, of thinking about a problem.
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We are taught that if you do induction and abduction, induction and deduction, it is enough, is what is expected from you. Abduction is for other people. Abduction is for the smart people who
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don't live in Iraq. Or otherwise, somewhere there, out, not for you an abduction is for you and the abduction was The system of abduction was a great American logician, a wonderful man in the
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19th century, Charles Pills, and humble, he died in poverty and created this enormous body of work, which is called abduction.
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So what is abduction? In the philosophical literature, abduction is the term is used to refer to some form of explanatory reasoning, in the sense in which it is used more frequently in the modern
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literature, it refers to the place of explanatory reason in justifying the hypothesis.
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In the latter sense, abduction is also often called inference to the best explanation. And that's how we will call it as from the next lecture. Today, we still will go with abduction because it
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goes nicely, induction, deduction, adduction, no? But in this lecture, we'll talk about inference of the best explanation. And that is clinical research, that's all,
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no more. That's the inference of the best explanation is the purpose is the guiding light of clinical research For peers,
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the guy who invented developed that the concept of adduction, adduction has its proper place in the context of discovery,
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the stage of inquiry in which we try to generate theories which may then later be assessed.
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As he says, adduction is the process of forming explanatory hypothesis It is the only logical operation with introduces any new ideas.
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And I know that you may be confused now because you say, what is this guy? What is Lassert is talking about? He's moving his hands a lot, but he's not talking about anything.
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What does it mean? Abduction is the only logical operation which introduces new ideas. And it's not said by the way, it's said by Charles Piers Explanatory
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hypothesis of what?
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But, okay, I wanted to introduce an explanatory hypothesis of what? And
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of the disease, we are clinician. So, abduction is the only review of the explanatory hypothesis of a disease. If we were engineers, okay, explanatory hypothesis of engineering, but we are not
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engineers, we are clinicians. So this planetary hypothesis of what of the disease, but what is the disease?
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Anybody can answer that question, what is the disease?
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What is the disease? I jump up, are you again? In the pension,
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the disease is in the patient. And I will tell you two or three stories
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by the end of this that shows you that the disease is in the patient. The disease is not in the air, just floating in the air. The disease is in the patient. And how we do abduction, abduction
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applied to clinical research. Are you following me more or less, right? So how we do abduction, I have to move this engine here in order to, uh, but.
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Nobody video, no, I can move, I can move the thing.
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How will you have that job? In every clinical interaction, in every clinical interaction, we have a patient, we have a rule about
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what the patient has, there is a body of knowledge that we'll have, and we have a result. The order of those three components, determines the type of logical process, guiding your thoughts. What
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I mean with that, is in your PDF form.
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Is this? So, induction, starts in the patient, confirms that their noses, validates the rule.
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You go and see the patient is at a kit with
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the mediated pupil, and you say,
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This kid has a mediative pupil to a CT scan or an MRI or some radiological study. And there is a mass on that side compressing the third nerve. And then there is sometimes, that mass of happening
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in the 19th century came the rule. But somebody has a mediatic pupil, most likely as
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an interceded oral mass It's a rule, it's created a rule. And you apply, so now you apply to the patient, you do a test, and you validate the rule. And year after year after year after year, we
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validate that rule.
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The reduction starts with a rule. It says rule to patient and to result, the result confirms the rule. You know to the rule, Every patient who has been the arthrita, every individual who has been
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the arthrita. Mediatic has a,
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you have to eliminate the possibility of in the camera mass, you go to the patient, you go to the water, this child is that, do an MRI, MRI confirms the rule. Okay, abduction, what abduction
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does? And it's a subtle difference. What is abduction does? Stars with a rule,
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every medrata, tata, tata, tata. Then the result,
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so far you do very similar to the latching, but ends with a patient. The good clinician ends with the latching and the latching. Goodbye, done. The clinical researcher says,
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What happened to this one,
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is this hematoma
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as big as the last one I've seen, thus
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the size of the hematoma affects the responsiveness of the pupil, I don't know, I'm just throwing an idea, maybe
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if you can analyze the volume of the hematomas and the response of the different patients to that volume of hematomas in the future, you can say, okay, maybe this hematoma can't wait, and we have
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to cancel Professor Host's case to put this to an hematoma, or you can say, no, following all our observations and our clinical research, we can say, that most likely this anatoma can wait to go
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to surgery two or three hours, this child with the anatoma. So the abduction ends in the patient, induction starts with the patient. The addiction starts with the rule. Those are the good doctors.
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The abduction, the doctor who does abduction is the one who asks why this patient. And I have two stories to tell you. Yeah, we have time for that. That confirmed this issue. So imagine this and
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it goes from rule to the patient. I have to move all the screens in here. And for example, rule in patient with subdural anatoma
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I'm Barakaria, Consider Elevated Interconnect Pressure. that is known by everybody. The patient, this patient with a duraliometoma has radicardia vessels. We start the treatment, start with
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manitol or extroventricular pain, and
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the heart rate improved. We control the intercranial pressure.
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Induction, and I use a duraliometoma, of course, has to go to it as a surgery. I imagine, I will say follow. So I should have put a duraliometoma I status a duraliometoma. So think of
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iracephalos instead of SDH. Induction starts in the patient, confirms the diagnosis where it is the rule. The patient with
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iracephalosabaticaria, we start the treatment with Maritol, or extroventricular drain, and the heart rate improved in patients with subduraliometoma, or iracephalosabaticaria,
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considered elevated in kind of pressure.
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It starts with a rule, confirms the result, the value is the rule, and then goes to the patient and asks why this one. The rule in the patient with sardiolumatoma and bradycardia one, you are
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reading that. But the adoption lies, okay, this patient with a sardiolumatoma or
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either cephalosas bradycardia. We all jump into the thinking of the bradycardia being related to the sardiolumatoma, that's the way you're saying. Maybe the sardiolumatoma or theerycephalos, think
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oferycephalos.
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It's not related, it's not the cost of the bradycardia. Maybe that the patient has another problem, another cardiac problem. Mermy, the regular rate of this patient is the same. Maybe he's one
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of those individuals who's a hard rate, he's a lot of
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or the per minute. because it's a marathon runner. And I don't say follows of the thing, doesn't have anything to do.
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And then you are trying to start thinking, start a process of clinical research. I am fascinated by this point of why this individual, we did the seven-two-kilow drain,
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it's very carried and improved. What's the relation between the supposed intracranial pressure and the supposed brachycardoia? I do remember when I was at the residence and I didn't know anything
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about the doctor, we had a patient with a child, the patient was a child with massive
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synostosis of the tissue to coronal and saggid, both not rambles.
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but coronal and sagittal suction, the head compressed,
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the interpressure was in the clouds.
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But the
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child was fine. In the cardiac area was there, was he was sitting in the bed plane with the monitor of the interpressure. Of course,
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with the granular facials, we took him to the surgery after But that was an occasion lost to me because I did that perfectly in that chum, in that chum that in,, in that chum chum, not a proctor,
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but never asked it a question about that patient. And that patient haunted me for so long that I still know his name.
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I can't tell you his name. I mean, it would not, doesn't make any difference, but I remember his name We say why Chris Christopher was his first name? had this outcome? What can we know about
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the meaning of intraconial pressure? And he developed a normal life after all. So, abduction demands an explanation of why this patient. And from that explanation is that you go the next step and
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come with an idea. I will tell you a case, not from neurosurgery or neurosciences, from the 18th century. I don't see you all. So, let me see if I put a
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greeting here.
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I'll show you a video now. But anyway, for some reason, I just see myself, which is good. You all wash your hands, right?
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When you go in cleaning and the patient in cleaning, you all wash your hands, everybody wash their hands. These are mandatory things. How the idea of washing the hands came.
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And they said, We need to wash our hands. No.
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There was one patient that attracted his attention.
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I will tell this story briefly without any illustration Perperal fever,
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or the fever or the infection of that kills the women who are pregnant to what about the
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living. So, it's a streptococcal infection. They have in Vienna
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in the 1860 Morales around the time they had in Vienna, they had a huge hospital And they have two wards of obstetric wards, ward one and ward two. In ward two, the mortality was 10 more or less
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for perperal fever. In ward one, the mortality was 40, 50.
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people died in half every two patients, one died. He went to ward one. And this was so well known in Vienna that pregnant ladies preferred to deliver in the street rather than be admitted to ward
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one. And they tried every, that is method More respondents, more those talents, and it is beautifully described in a book on philosophy of science. They thought was the priest, they thought was
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the heir, they thought was the position because the, remember, this is
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1860, 1845, 50, before the bacteria. People didn't know that bacteria succeeded. So they were thinking rather than,
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some advice was in charge of this thing Um goes to Venice for a vacation. And one of his colleagues, Dr. Collextra, the patient in our case, is doing an autopsy of a woman, of a lady who died of
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corporal fever, catches a finger,
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and then develops the same size of corporal fever, which is peritonitis, pleuresia, pericarditis, and some meningitis, all the mucosa and the cirrhosis inflates.
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So, some of us start thinking, OK?
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Forget about all the women. Forget about all the things. Let's think about Collextra. Let's think about
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this patient.
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He's not a woman, thus he's not pregnant. but that's the same symptoms as the other women.
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So you see, he's not thinking of poor payroll fever. He's not thinking of pregnant women. He's not thinking of anything. He's thinking of cholesterol,
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right? He's doing pure abduction. Abduction wasn't described yet, but he's doing pure abduction. So he says, what cholesterol do you, what happened to him? Well, he was in an autopsy, doing
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an autopsy of a woman, he cut his finger. So I say, okay, there is a catalytic factor, a factor in the calaver. Remember, that was before Pasteur. People didn't know anything about our
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bacteria. It's a catalytic factor.
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And
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just in case, let's wash our hands, totally
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after we do autopsy and before which I mean. patient. Sure enough, the number of the mortality reduced in word one. Then comes another thing, then comes another patient, not the group, a
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patient. So those doctors did, and I will add something at the end, did the autopsy in the morning. The mortality was in, people were learning through autopsy. There was no internet there, so
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they learned through autopsy. The learned autopsy
44:28
was their hands months, and they go to the world. It's some in there, the patients of the day. So happens one day, very few weeks after, a lady comes already infected. The process of infection
44:45
is this, the the uterus, because it's already shown. is about to deliver is stretch and has cracks get the infection with it a streptococcal. Canceled who didn't deliver yet but was already
44:60
infected.
45:02
She's the first patient that they had salmon. They do the examination to determine when and then they had salmon the second patient the third and that day they ate salmon 11 patients. They live and
45:17
died.
45:19
I mean it's I mean 10 patients plus the lady who had it. So by the phenomenon of one patient, some advice comes and says you need to wash your hands between patients also
45:35
and that's it.
45:38
The most simple rule of medicine the one that you think come on it is of course that you have to wash your hands. If you wash your hands before eating, right, you wash your hands. part of the norm
45:51
thing. No, with one patient, Colestia, he was thinking about, he was doing abduction in Colestia. Why Colestia? What's happening to him?
46:03
And one more thing.
46:07
I told you, grade one,
46:17
I mean, word one and word two. In word one, they were mortality was high In word two, mortality was not as high.
46:22
When they were examining all the things of induction, why the difference between the words, they missed, I think, as big as an elephant. Remembering induction on the fallacies of induction in the
46:39
fallacy at hominem. I mean,
46:42
if
46:44
that, that guy who is very smart says it must be true. or if that person who is an idiot says something must be wrong, right? That fallacy of dominant. The big fallacy of dominant was, word one,
46:60
the delivery was by physicians. War two, the delivery was by midwives, by nurses, not by physicians. Nurses didn't do autopsies
47:16
Decisions did autopsies.
47:20
You say, But come on. You didn't notice that.
47:26
It was a big as an elephant was there. One side and by the nurses and the other side, by the daughter, yeah? Not even seven vice-gobel.
47:38
Seven vice-gobel was as biased as anybody else in the world. No, come on, the nurses, what they know, of course,
47:47
Last case, and with that, I finished on the set of abduction and
47:55
for Friday, we will talk about researching Saudi Arabia, how the uses of abduction in that research in Saudi Arabia recently published, published in the last five years, on Milo Meningale. So,
48:09
Henri Laboret was a surgeon, a general surgeon, navy surgeon, French. He was born in Vietnam, but he was a French family, and
48:32
he stationed in
48:36
Tunis. He stationed in Tunis, and his patients have a tremendous, maybe not been a very good surgeon because he was worried about the bleeding of their patients, right? The patients bled, and
48:43
bled, and bled, and bled, and the posture was complicated.
48:48
So he reads somewhere that I'm talking about 1950 something. He reads on, oh yeah, 1950 something. He reads somewhere that the histamine, as you know, is a vasodilato.
49:04
So if you take an anti-histamine, you have vasoconstriction, right? No, you know that. That's why when you have allergy, you take an anti-histamine to have vasoconstriction So you say, Gee, I
49:19
will give my patients anti-histamine.
49:24
So they will bleed less.
49:28
And what I am telling you is not a
49:33
script I made for you. It is verbatim from his paper. He published his paper in the Belgian Journal of Surgery. So what it does?
49:48
gives the patient anti-estaminates and apparently he got happy because the patients were doing better and the theory is wrong because the anti-estaminates do not prevent a more rigid shock but then he
50:04
was fine he was happy but then what he saw that the patient, one patient, one patient was scarmed after surgery. I was was suffering before surgery for the thing, he didn't like them, the navy,
50:22
all those things and then he was calm and then he said he did a reduction, he said why this patient is calm? Then you look at other patients, he's calm too, then you look at other patients, he's
50:38
calm too, of course anti-estaminates, take place you'll see in your activity. That's why you shouldn't take anti-estaminates when you're about to drive. on the street, right? If you look at the
50:51
label of anti-stamine, you say, Do not take if you are about to handle heavy machinery or pilot a boy in drought or Dubai. I mean, don't take anti-stamine. You will be sort of wobbly. So you
51:05
guys say, Wow, there is something. And then from that observation, Laboreth became one of the most famous physiologists in the world. It's the guy who discovered the chloropromacy, which changed
51:21
the world and the life of schizophrenia patients.
51:26
So from doing one thing, Gee, my patients are bleeding. Oh, well, I read in this paper, and that was one. Anti-stamine, it's hard for anything to do with hemorrhagic shock. Maybe he improved
51:42
his surgical technique and his patients were bleeding less. And then, by the observation, one patient. I have two or three more cases to show, but next week will be more conversation, maybe one
52:01
or two slides, and we will cement the idea that in the patient and through abduction, the idea has come. And then on the other three, we will expand on how to develop the genesis and development.
52:18
But I think it is clear, is the patient, is the patient, is the observation, just look, and the ideas don't come knocking the door. You have to look what happened to laborate, and we happen to
52:34
symbolize. And symbolize statues, at least, was in my medical school, as a hero of medicine. They're going to
52:45
just pay the attention. And why paid attention because Koleska was his close name.
52:52
I said, Fuck, I mean, Koleska, why Koleska are? And that is what I say motivated by compassion. He was interested in that patient. Why my dear friend I? And then he found that we have to wash
53:06
over the hands. So with that,
53:11
I
53:13
thank you. Thank you to all of you And if you have any any questions, please.
53:25
Any questions on the moment or no?
53:34
If you want to ask a question directly, you can, and if you want to post it in the chat, it's alternative. Yeah. All right, me. You have the address. Write me about this at the question and
53:47
search, you know you Thank.. Thank you.
53:51
And the, at the point again is this, this lecture one, lecture two are kind of boring and maybe it may be more interesting It may be more interesting at the end, but the three will talk about a
54:05
research paper, fantastic research paper that I don't know if the researchers knew that they were using that action and they perfectly fit
54:16
in our lecture series They fit because they, they talked about an issue I know which is my domain English selling.
54:24
Okay then. So.
54:30
Thank you all of you.
54:34
We hope you enjoyed this presentation.
54:40
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