This is a lecture by Katherine A Perry from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Chronic obstructive pulmonary disease (COPD)- Preeti sharmaEducate with smile
COPD is a type of obstructive lung disease and related conditions. it is very helpful presentation to you about information of COPD.
It includes all things that is definition, causes, symptoms, pathophysiology, diagnostic evaluation, types, treatment and role of nurses for COPD patient.
This is a lecture by Katherine A Perry from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Chronic obstructive pulmonary disease (COPD)- Preeti sharmaEducate with smile
COPD is a type of obstructive lung disease and related conditions. it is very helpful presentation to you about information of COPD.
It includes all things that is definition, causes, symptoms, pathophysiology, diagnostic evaluation, types, treatment and role of nurses for COPD patient.
Diagnostic tests for GI disorders- include physical evaluation, blood tests, imaging techniques. Learn the methods of diagnosis in detail, for gastrointestinal disorders.
This presentation contains :-
1.Definition of stiz bath
2. Uses of sitz bath
3.Procedure of sitz bath
4. Introduction to procedure
5. Definition of episiotomy
6. Types of episiotomy
7. Precaution in sitz bath
8. Addition of solution in water to take sitz bath
9. Caution during sitz bath
Diagnostic tests for GI disorders- include physical evaluation, blood tests, imaging techniques. Learn the methods of diagnosis in detail, for gastrointestinal disorders.
This presentation contains :-
1.Definition of stiz bath
2. Uses of sitz bath
3.Procedure of sitz bath
4. Introduction to procedure
5. Definition of episiotomy
6. Types of episiotomy
7. Precaution in sitz bath
8. Addition of solution in water to take sitz bath
9. Caution during sitz bath
Alternative medicine is any practice that aims to achieve the healing effects of medicine, but which lacks biological plausibility and is untested, untestable or proven ineffective. Complementary medicine (CM), complementary and alternative medicine (CAM), integrated medicine or integrative medicine (IM), and holistic medicine are among many rebrandings of the same phenomenon. Alternative therapies share in common that they reside outside medical science, and rely on pseudoscience. Traditional practices become "alternative" when used outside their original settings without proper scientific explanation and evidence. Frequently used derogatory terms for the alternative are new-age or pseudo, with little distinction from quackery.
INDIAN SYSTEM OF MEDICINE, UNIT1, MPHARM PCG SEM2
Fundamendal concepts of Traditional Medicine
Ayurveda
Siddha
Unani
Homeopathy
Ayurveda – Pharmacopoiea, Analysis of formulations
Siddha – Gunapadam, Types of medicines,Dhatu Jeevam moolikai Purification(Suddhi)
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. The endocrine system is a network
of glands that produce and release
hormones that help control many
important body functions, especially
the body's ability to change calories
into energy that powers cells and
organs.
INTRODUCTIO
N
3. In 1973, the Medical Faculty of the University of Rome
convened the first World Congress of Alternative
Medicines and the provisional program contained no less
than 135 therapies. Alternative medicine exists in all
cultures to some degree and terms such as traditional
medicine, indigenous medicine or folk medicine etc. are
used to describe such practices. These medicines date back
hundred or even thousands of years depending on the
country and culture concerned. There are more than 100
systems of alternative medicines still in practice all over
the world. Every country, region or area has its own
traditional system of health and medical cares.
5. The system of medical
practice which treats
disease by the use of
remedies which produce
effects different from
those produced by the
disease under treatment.
Also known as
conventional medicine.
ALLLOPATHY
:
6. The term Alternative Medicine
means any form of medicine
that is outside the mainstream
of western medicine or
conventional medicine as
practiced by a majority of
doctors today.
ALTERNATIVE
MEDICINE
7. Complementary medicine refers to healing practices and
products that work in conjunction with traditional
medicine.
COMPLEMENTARY MEDICINE
8. Integrative medicine draws from
both complementary medicine and
alternative medicine and combines
these with traditional Western
therapies.
INTEGRATIVE MEDICINE
10. MOTIVES
•POSITIVE
MOTIVES
•Perceived
effectiveness or
safety
•Spiritual
•Holism
•All things natural
•Active role
•Control over
treatment
•Pleasant
therapeutic
experience
•NEGATIVE MOTIVES
•Dissatisfaction with
conventional health
care
–Ineffective
–Adverse effects
•Doctor-patient
relationship
–insufficient time
–waiting lists
•Reject science and
technology
•Reject “the
establishment”
•Desperation
12. TYPES OF CAM
The National Centre for Complementary and Alternative
Medicine (NCCAM) recognizes five main categories of
complementary and alternative medicine:
13. •Mind-body medicine. Mind-body medicine includes
treatments that focus on how our mental and
emotional status interacts and affects the body's
ability to function. Examples include meditation and
various therapies expressed through art and music.
14. •Whole medical systems. This category refers to complete
systems of medical theory and practice, many of which go
back thousands of years and have roots in non-Western
cultures. Examples include traditional Chinese medicine
and Ayurveda a therapy that originated in India. Whole
medical systems from the West include homeopathy and
naturopathy.
15. •Manipulative and body-based practices. Relying on the
physical manipulation of the body, this practice is intended
to improve specific symptoms and overall health.
Examples of these practices include chiropractic and
osteopathy.
16. •Energy medicine. This form of alternative medicine uses
energy fields to promote healing. Bio field therapies affect
energy fields that are said to encircle the human body —
forms include Reiki and qi gong. Bio electromagnetic-
based therapies, such as magnet therapy, involve the
manipulation of electromagnetic fields.
17. •Biologically based practices. Since the focus is on herbs,
nutrition, and vitamins, dietary supplements and herbal
medicine are perhaps the most common forms of
biologically based complementary and alternative
medicine. A growing interest in these kinds of therapies is
leading to more research, but many of these biologically
based practices have yet to be thoroughly tested.
19. Acupuncture
Fine needles are inserted at specific points to stimulate,
disperse, and regulate the flow of vital energy, and restore
a healthy energy balance. In addition to pain relief,
acupuncture is also used to improve well being and treat
acute, chronic, and degenerative conditions in children and
adults.
20. Acupuncture can be used to restore hormonal balance,
regulate energy levels, smooth emotions, help manage sleep
and menstrual problems, restoring immune function and
balancing the production and release of hormones.
Acupuncture is so helpful in the treatment of endocrine
disorders, as they focus on balancing all of the glands.
Acupuncture treatments work towards improving the
patients overall health and well being.
21. Acupressure
Similar to acupuncture, but
using finger pressure rather
than fine needles on specific
points along the body to
treat ailments such as
tension and stress, aches and
pains, menstrual cramps,
arthritis
22. Acupressure is used to diagnose various health problems
and treat emotions, tensions and physical conditions by
regulating energy and maintaining yin and yang
equilibrium. The process of acupressure focuses on
restoring the normal energy flow within the body.
Acupressure point is a very important one that is said to
help controlling not only diabetes but also reduce
headache and other ailments. Various points found on
several different meridians are used to treat
hypothyroidism.. A point called Yintang, located between
the eyebrows, activates the pituitary, which, in turn,
controls the thyroid.
23. Aromatherapy
Using "essential oils" distilled from plants, aromatherapy
treats emotional disorders such as stress and anxiety as
well as a wide range of other ailments. Oils are massaged
into the skin in diluted form, inhaled, or
placed in baths. Aromatherapy is often used in conjunction
with massage therapy, acupuncture, reflexology,
herbology, chiropractic, and other holistic treatments.
In the endocrine system, oils
like geranium, lavender,
ginger, rosemary etc are used
for over and under active
glands.
24. Astrology
Astrology is a humanistic attempt at trying to understand
the cycles that we share with the forces in the Universe.
The planets have corresponding ruler ship to certain
vitamins, minerals, cell salts, herbs, metals, colors and
parts of the body.
25. Saturn and Mars rule different parts of the adrenal glands
respectively. The adrenals sit on top of the kidneys (renal
system). So any challenging aspects between Saturn and
Mars can indicate a pattern of a stressed endocrine system
(specifically referring to the adrenals).
26. Ayurvedic Medicine
Practiced in India for more than 5,000 years, ayurvedic
tradition holds that illness is a state of imbalance among
the body's systems that can be detected through such
diagnostic procedures as reading the pulse and observing
the tongue. Nutrition counselling, massage, natural
medications, meditation, and other modalities are used to
address a broad spectrum of ailments.
27. The three Doshas, which are
invisible, are more about the
working state and system of the
body.
Vata shows- high in activity
Pitta is a state where body is on a
normal mode
Kapha- which tells that system is
slow and sluggish.
The same is the endocrinology or
effect of endocrine glands on the
body. There are three states of the
body, under the effect of the
glands- Hyper, Hypo and Normal.
28. Autogenic Training
It is a century-old European method for achieving
relaxation based upon passive concentration and body
awareness of specific sensations. Its effectiveness has been
shown in relieving many stress-related disorders including
anxiety, tension, insomnia, and examination stress. Persons
with chronic medical conditions ranging from migraine,
colitis, irritable bowel syndrome, diabetes, high blood
pressure, to thyroid disease and many other conditions
have also been shown to benefit from this practice.
29. Cellular Therapy
Refers to various procedures in which processed tissue
from animal embryos, fetuses or organs, is injected or
taken orally.
The organs and glands used in cell treatment include
brain, pituitary, thyroid, adrenals, thymus, liver, kidney,
pancreas, spleen, heart, ovary, testis, and parotid.
30. Chinese (Oriental) Medicine
Oriental medical practitioners are trained to use a variety
of ancient and modern therapeutic methods - including
acupuncture, herbal medicine, massage, heat therapy, and
nutritional and lifestyle counseling - to treat a broad range
of both chronic and acute illnesses.
31. Adaptogens can be taken by most people for improved
well-being, although it is important to correctly match the
herb to the person. Adaptogen herbs are used for people
with adrenal fatigue and thyroid disorders.
32. Herbalism
An ancient form of healing still widely used in much of the
world, herbalism uses natural plants or plant-based
substances to treat a range of illnesses and to enhance the
functioning of the body's systems. Though herbalism is not
a licensed professional modality in the United States, herbs
are "prescribed" by a range of practitioners.
Cushing syndrome, hyperthyroidism, hypothyroidism etc
can be treated with certain herbs.
33. Naturopathic
Medicine
Naturopathic physicians
work to restore and support
the body's own healing
abilities using a variety of
modalities including
nutrition, herbal medicine,
homeopathic medicine, and
orient medicine.
Naturopathic medicine helps
people overcome adrenal
and thyroid disorders and
achieve lasting fat loss and
vibrant energy.
34. Reflexology
This modality is based on the idea
that specific points on the feet and
hands correspond with organs and
tissues throughout the body. With
fingers and thumbs, the
practitioner applies pressure to
these points to treat a wide range
of stress-related illnesses.
Foot reflexology is used for
hyperthyroidism, hypothyroidism,
hyperparathyroidism,
hyperparathyroidism,
hyperinsulinism, hypoinsulinism,
hypogonadism etc.
35. Siddha medicine
Usually considered as the
oldest medical system known
to mankind. Contemporary
Tamil literature holds that the
system of Siddha medicine
originated in Southern India,
in the state of Tamil Nadu.
Siddha is reported to have
surfaced more than 10,000
years age.
36. Siddha medicine can cure ovarian diseases, erectile
dysfunctions, thyroid disorders, diabetes, menstrual
problems etc by its own ways of treatment which is written
before centuries.
37. Tibetan Medicine
Evolved as a synthesis of Tibetan, Chinese and Persian
Medicine, and even Ayurveda. These remedies include
indigenous herbs, fruits, flowers, metallic powders and
minerals given in tablets, and are especially effected in
treating rheumatism, asthma, gastritis, diabetes and many
neurological disorders.
38. Unani
The Unani System of Medicine originated in Greece
(Unan).Hippocrates ( 460 – 377 BC),the “ Father of
Medicine” freed medicine from the realm of superstition
and magic and gave it the status of science. The teachings
of Hippocrates form the basis of the theoretical frame
work of Unani Medicine. Though, all the different systems
of medicine considers “Hippocrates” as the Father of
Medicine, the Unani System of Medicine is the only system
of medicine still following the principles of medicine laid
down by Hippocrates.
39. In the treatment of diabetes, the most important difference
between, western medicine and Unani treatment is that,
Unani therapy try to make the pancreas to once again
functional at a normal and their natural level. There is no
western medicine, which rejuvenates the pancreases.
Unani, with its herbo-mineral treatment course achieve
this.
40. HERBO DIABICAN CAPSULES is a combination of
Herbal anti-diabetic herbs recommended for more than
50000years in Unani. It helps to act on different sites in
different ways to effectively control factor and pathways
leading to Diabetes Mellitus. It is an herbal supplement
which helps to correct the effects, besides the condition
itself and correct the degenerative complications which
result because of diabetes.
It is safe and effective and helps to manage Diabetes
Mellitus.
41. Yoga Therapy
The use of yoga is to address mental and
physical problems while integrating body and
mind. Sarvangasana is the most well
recognised asana for thyroid gland. Other
effective asanas include surya namaskara,
pawanmuktasana, which are used for severe
thyroid diseases. While medical science claims
diabetes is incredible, many studies have
proven that it responds very well to yogic
management. It is important that diabetes
undertake yogic therapy in conjunction with
qualified medical supervision. The yoga
sadhana and progress of every diabetes will
vary according to individual conditions.
42. CONCLUSION
Alternative therapies refer to a broad group of natural
and spiritual healing methods that are different than
the conventional western medicine (or pharmaceutical
medicine).
Researchers thus observe that the people are shifting
their allegiance to the Indian alternative therapies,
because these therapies are natural and have no side-
effects. The western medicine has failed to deal with
the chronic diseases as well as new, antibiotic-resistant
bacteria. Ancient therapies, by contrast, have an
excellent record of curing the chronic diseases that do
not respond well to western medicine.
43.
44. ASSIGNMENT
What is the difference between
allopathy, conventional
medicine, alternative medicine
and integrative medicine and
submit it on 13-3-2015