GENERAL PATHOLOGY AND HISTORY OF MEDICINE
Learning outcomes of the course unit
Once completed the Course, the Student will have a thorough knowledge and understanding of the etio-pathogenetic factors underlying the basic structural and functional alterations in humans, and the relative response mechanisms, at the different levels of integration (molecules, cells, tissues, organisms).
Students are also expected to be able to apply this knowledge, integrated with information from previous Courses, to the comprehension of the pathophysiology of common human pathologies.
Moreover, the student will be able to consider medical information in an historical perspective.
Mandatory previous examinations are identified by the Council of the Medical school. Adequate bases of chemistry, cytology/histology, anatomy, biochemistry, microbiology, immunology, oncology and physiology are required.
Course contents summary
The Course will provide scientific bases to the practice of medicine, defined as the capability to identify clinical conditions affecting human beings and to promote preventive or therapeutic to implement individual and community health. The Course will concern:
- Cell Pathology
- Molecular Pathology
- Tissue responses to cell injury: inflammation, hemostasis, repair
- General pathophysiology.
The Course will be integrated by lectures concerning the history of medicine.
PATHOLOGY AND PATHOPHYSIOLOGY
1) MOLECULAR PATHOLOGY
- Monogenic Mendelian disease (with relevant examples)
* autosomic dominant
* autosomic recessive
- Monogenic non-mendelian diseases (with examples)
- Polygenic multifactorial diseases (with examples)
- Chromosomal alterations
- Disorders of gene expression and phenotypic effects of mutations
- Examples of protein disorders
* hemoglobinopathies and thalassemias
* channels and transporters
* hormones and receptors
2) CELL PATHOLOGY
- Cell damage: reversible vs. irreversible
- Protein misfolding: ER stress and UPR
- Intracellular accumulations: protein accumulation, steatosis, lysosomal diseases
- Extracellular accumulations: amyloidosis
- Oxidative stress and the cell response
- Ethanol toxicity
- Ischemic and hypoxic stress. Cell and tissue adaptation to hypoxic-ischemic stress
- Types, biological significance and mechanisms of cell death
- Cell aging, organism aging and progeroid syndromes
3) THE RESPONSE TO TISSUE DAMAGE
- Hemostatic mechanisms
- Hemorrhagic disease
- Thrombosis (mechanisms, Virchow's factors, evolution and consequences)
- Embolia (concept, types, consequences)
- Innate immunity and inflammation triggering
- Acute inflammation: phenomena, cells, mediators, types
- The inflammatory exudate (mechanism of formation, types)
- Mediators of the inflammatory response (exogenous vs. endogenous; cellular vs. plasmatic; preformed vs. neosynthesized; the complement system; the kinine system; histamine; eicosanoids; the cytokines; nitric oxide; antiinflammatory mediators)
- The resolution of the acute inflammatory response
- Chronic inflammation (the infiltrate, mechanisms, cells, evolution)
- Inflammatory lesions: abscesses, ulcerae, granulomas
- Systemic phenomena in inflammation (leukocytosis, acute phase response, the inflammatory stress, metabolic changes)
- Defects of the inflammatory response
- Autoinflammatory diseases
- Mechanisms of tissue repair
- Derangements of tissue repair mechanisms
- Osmotic and Volume disorders: * pathophysiology of water and sodium
* Pathogensis of edema
* Hypovolemia and shock
* Hypernatremia and hyponatremia.
* Disorders of potassium homeostasis: hyperpotassemia and hypopotassemia.
disorders: acidosis and alkalosis.
* Disorders of calcium, phosphorus and magnesium.
- Endocrine disorders
* Endocrine defects (hormone deficits, receptor defects, post-receptorial defects)
*Endocrine hyperactivities (hormone excess, receptor hyperactivity, excess of signal transduction)
- Pathophysiology of metabolism:
*Alterations of purine metabolism
* Alterations of lipid metabolism
* Diabetes Mellitus: etiologic factors, types, pathophysiology of metabolic alterations and complications
* Porphiries and jaundice
* Iron and copper. Iron deficiency and overload.
* Aminoacidopathies (
Hyperphenylalaninemias, Urea cycle defects, Hyperomocysteinemia)
* Inherited disorders of carbohydrate metabolism (glycogenoses, fructose intolerance, galactosemia)
* Disorders of Fatty Acid Oxydation
* Inherited disorders of nutrient ransporters (defects of glucose transporters, cystinuria)
- Pathophysiology of nutrition.
* Hypovitaminosis and hypervitaminosis
HISTORY OF MEDICINE
- The origins: before Greeks
- Greece and Rome
- Outside the Mediterranean sea: India and China
- Middle Ages: plagues, hospitals, universities
- The modern age: the anatomical revolution and the rise of physiology
- XIX and XX centuries: from the illuminism to the molecular revolution
- XXI century: Technologies and perspectives
- New and old diseases
- The Black Death
- Virchow and the origin of experimental medicine
- Kumar, Abbas, Fausto, Aster (Eds). Robbins e Cotran – Pathologic Basis of Disease - Elsevier Masson, 2015
- Mainiero, Misasi, Sorice (Eds.) Patologia Generale e Fisiopatologia Generale,
2 vol. VI edizione
Altucci, Berton, Moncharmont, Stivala (Eds.)
Patologia e Fisiopatologia Generale, 2 vol.
Harrison's: Principles of Internal Medicine. McGraw-Hill Ed., 19th ed, 2015
McCance, Huether, Brashers, Rote Fisiopatologia ed elementi di Patologia Generale
HISTORY OF MEDICINE
Storia della medicina e della sanita` in Italia-Laterza, 2004.
L'arte lunga. Storia della medicina dall'antichità a oggi
Storia e teorie della salute e della malattia Carocci, 2014
Additional references will be suggested during the lectures.
Interactive oral lectures, based on the explanation of the main conceptual frame of each subject, supported by graphical presentations which will be available to the students on the Elly platform. This material will be useful to support the individual learning process but, by no means, should be considered sufficient for the preparation of the exam. Examples taken from the medical practice will be provided together with bibliographic references so as to stimulate students to raise questions, to go in depth in subjects of interest or to provide answers to simple problems presented by the teacher. The course will be integrated with optional laboratory practice.
Assessment methods and criteria
No interim summative evaluation is programmed, while valutative or diagnostic evaluations will be possible.
The final summative evaluation will consist in an oral examination, integrated by a powerpoint presentation on a subject concerning history of medicine, which will be also discussed and evaluated during the oral examination. Failure to forward the presentation of history of medicine at least 10d before the oral examination or insufficient quality of the presentation will prevent the success of the oral examination.
For Pathology/Pathophysiology the oral examination will consist of 2 questions/student (from different examiners). Each question will concern a pathologic process enlisted in the detailed program. The examiner will enunciate the process, using a subject enlisted in the program, or will delineate a situation of clinical relevance in which a pathologic process is clearly involved.
In the first case, the candidate shall provide the definition of the process and will discuss causes, mechanisms and involvement in human pathology with the examiner.
In the second case, the candidate shall identify the process involved in the clinical situation and will discuss it with the examiner.
Failure to answer to one of the two questions, or the verified uncapability to define or identifying correctly the pathologic process, will prevent the successful completion of the exam.
The outcome will be also negative if, during the discussion, the student will exhibit severe pitfalls, not compatible with an adequate understanding of the subject.
After each question, the examiner will give an evaluation expressed in marks:
A. Very good knowledge and understanding. Very good capability of
applying knowledge to bio-medical problems. Corresponding to 30/30.
B. Good knowledge and understanding. Good capability to apply knowledge to biomedical problems. Corresponding to 27-29/30.
C. Average knowledge and understanding. Average capability of applying knowledge to bio-medical problems. Corresponding to 24-26/30
D. Sufficient knowledge and understanding. Sufficient capability of
applying information to bio-medical problems. Corresponding to 21-23/30.
E. Barely sufficient knowledge and understanding (with evident pitfalls).
Scarce capability of applying knowledge to bio-medical problems.
Corresponding to 18-20/30.
The final vote will be decided jointly by the examiners, taking into account the evaluation of the presentation of History of Medicine. The Committee will have the possibility to decide a vote not higher or lower than three grades from the best or the worst vote derived from the mean of the two individual votes.
Full marks with laude will be reserved to students exhibiting, together with an
overall evaluation of 30/30, good communication skills and capability of autonomous in depth-analysis of the subject.