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Cause (medicine)

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Cause, also known as etiology /iːtiˈɒlədʒi/ and aetiology, is the reason or origination of something

The word is derived from the Greek αἰτιολογία, aitiologia, "giving a reason for" αἰτία, aitia, "cause"; and -λογία, -logia

Contents

  • 1 Description
  • 2 Chain of causation and correlation
  • 3 Etiological heterogeneity
    • 31 Endotype
  • 4 See also
  • 5 References
  • 6 External links

Description

In medicine, the term refers to the causes of diseases or pathologies Where no etiology can be ascertained, the disorder is said to be idiopathic Traditional accounts of the causes of disease may point to the "evil eye" The Ancient Roman scholar Marcus Terentius Varro put forward early ideas about microorganisms in a 1st-century BC book titled On Agriculture

Medieval thinking on the etiology of disease showed the influence of Galen and of Hippocrates Medieval European doctors generally held the view that disease was related to the air and adopted a miasmatic approach to disease etiology

Etiological discovery in medicine has a history in Robert Koch's demonstration that the tubercle bacillus Mycobacterium tuberculosis complex causes the disease tuberculosis, Bacillus anthracis causes anthrax, and Vibrio cholerae causes cholera This line of thinking and evidence is summarized in Koch's postulates But proof of causation in infectious diseases is limited to individual cases that provide experimental evidence of etiology

In epidemiology, several lines of evidence together are required to infer causation Sir Austin Bradford-Hill demonstrated a causal relationship between smoking and lung cancer, and summarized the line of reasoning in the epidemiological criteria for causation Dr Al Evans, a US epidemiologist, synthesized his predecessors' ideas in proposing the Unified Concept of Causation

Chain of causation and correlation

Further thinking in epidemiology was required to distinguish causation from association or statistical correlation Events may occur together simply due to chance, bias or confounding, instead of one event being caused by the other It is also important to know which event is the cause Careful sampling and measurement are more important than sophisticated statistical analysis to determine causation Experimental evidence involving interventions providing or removing the supposed cause gives the most compelling evidence of etiology

Related to this, sometimes several symptoms always appear together, or more often than what could be expected, though it is known that one cannot cause the other These situations are called syndromes, and normally it is assumed that an underlying condition must exist that explains all the symptoms

Other times there is not a single cause for a disease, but instead a chain of causation from an initial trigger to the development of the clinical disease An etiological agent of disease may require an independent co-factor, and be subject to a promoter increases expression to cause disease An example of all the above, which was recognized late, is that peptic ulcer disease may be induced by stress, requires the presence of acid secretion in the stomach, and has primary etiology in Helicobacter pylori infection Many chronic diseases of unknown cause may be studied in this framework to explain multiple epidemiological associations or risk factors which may or may not be causally related, and to seek the actual etiology

Etiological heterogeneity

Some diseases, such as diabetes or hepatitis, are syndromically defined by their signs and symptoms, but include different conditions with different etiologies These are called heterogeneous conditions

Conversely, a single etiology, such as Epstein-Barr virus, may in different circumstances produce different diseases such as mononucleosis, nasopharyngeal carcinoma, or Burkitt's lymphoma

Endotype

Main article: endotype

An endotype is a subtype of a condition, which is defined by a distinct functional or pathobiological mechanism This is distinct from a phenotype, which is any observable characteristic or trait of a disease, such as morphology, development, biochemical or physiological properties, or behavior, without any implication of a mechanism It is envisaged that patients with a specific endotype present themselves within phenotypic clusters of diseases

One example is asthma, which is considered to be a syndrome, consisting of a series of endotypes This is related to the concept of disease entity

Other example could be AIDS, where an HIV infection can produce several clinical stages AIDS is defined as the clinical stage IV of the HIV infection

See also

  • Bradford Hill criteria
  • Causal inference
  • Epidemiology
  • Molecular pathological epidemiology
  • Molecular pathology
  • Pathogenesis
  • Pathology

References

  1. ^ Rothman, Kenneth J; Greenland, Sander; Poole, Charles; Lash, Timothy L 2008 "Causation and Causal Inference" Modern Epidemiology Third ed Philadelphia: Lippincott Williams & Wilkins pp 6–7 ISBN 978-0-7817-5564-1 
  2. ^ Aetiology Oxford English Dictionary 2nd ed Oxford University Press 2002 ISBN 0-19-521942-2 
  3. ^ Greene J 1996 "The three C's of etiology" Wide Smiles Archived from the original on 2007-06-30 Retrieved 2007-08-20  Discusses several examples of the medical usage of the term etiology in the context of cleft lips and explains methods used to study causation
  4. ^ Meleis, Afaf Ibrahim June 1981 "The Arab American in the health care system" American Journal of Nursing PDF|format= requires |url= help 81 06: 1180–1183 doi:101097/00000446-198106000-00037 While germ theory is not refuted, it does exist side by side with other disease etiologies The evil eye al hassad or al ain al Weh- sha is one causative agent for the Arab 
  5. ^ Varro On Agriculture 1, xii Loeb
  6. ^ Maimonides: an early but accurate view on the treatment of hemorrhoids -- Magrill and Sekaran 83 979: 352 -- Postgraduate Medical Journal
  7. ^ Case study: the history and ethics clean air
  8. ^ Lötvall, J; Akdis, C A; Bacharier, L B; Bjermer, L; Casale, T B; Custovic, A; Lemanske, R F Jr; Wardlaw, A J; Wenzel, S E; Greenberger, P A 2011 "Asthma endotypes: A new approach to classification of disease entities within the asthma syndrome" J Allergy Clin Immunol 127 2: 355–60 doi:101016/jjaci201011037 
  9. ^ Castro, Kenneth G; Ward, John W; Slutsker, Laurence; Buehler, James W; Jaffe, Harold W; Berkelman, Ruth L 1993 "1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS among Adolescents and Adults" Clinical Infectious Diseases 17 4: 802–810 doi:101093/clinids/174802 JSTOR 4457386 

External links

  • The dictionary definition of etiology at Wiktionary

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