American Journal of Medical and Clinical Research & Reviews

The Pristine Text and the Bloodied One What the Library Keeps and the Clinic Wears: Archival Evidence and the Amulet on the King's Arm

2026-09-06T13:24:22+02:00

Deuteronomy 17:18 requires the king of Israel to write for himself mishneh ha-torah ha-zot — in the plain sense of the Deuteronomic legislator, a verified duplicate of the law, copied under priestly supervision and checked against a temple exemplar, so that the sovereign should stand permanently under a text he did not author.

The rabbis re-read mishneh as sheni, "a second," and generated two scrolls: one that goes out and comes in with the king, and one that lies in his treasury. A baraita at Sanhedrin 21b adds a startling detail: the travelling scroll is made k'min kamea, "in the manner of an amulet," and hung on his arm.

Rashi, commenting on the verse, transmits the doubling and omits the amulet; Maimonides, codifying the rule, retains the perpetual accompaniment and the bathhouse exclusion and likewise does not reproduce the simile.

This paper traces that trajectory — plain sense, midrashic doubling, thaumaturgic clause, pedagogical suppression — and argues that it maps with unusual precision onto a structural problem in clinical epistemology.

Medicine also keeps two texts: an archival exemplar that derives its authority from remaining uncorrupted by use (the textbook, the systematic review, the guideline in the library), and a working copy that derives its authority from wear (the compressed algorithm, the pocket card, the score, the clinician's own accumulated and unpublishable knowledge). Each fails without the other, and each fails characteristically: the archive becomes scholasticism, the worn text becomes talisman.

The halakhic apparatus surrounding the second scroll — it may be miniaturized to amulet size, it may go to war, it may not enter the privy or the bathhouse, because v'hayta imo v'kara vo requires "a place fit for reading in it" — supplies a transferable rule. What licenses compression is the preservation of readability. An instrument that can still be opened and checked is a text; one that is only carried is a charm.

The Patient Who Cannot Be Discharged Licensed Access, Retrospective Consent, and the Ethics of Release in the Clinical Encounter

2026-09-06T12:56:26+02:00

Background: Clinical medicine licenses access to the body and the interior life that would be intolerable in any other setting. It has developed elaborate procedural safeguards around that licence, and almost no vocabulary for what the licence does to the person who holds it or for what is owed afterward.

Approach: This paper reads that problem through a paradox in Deuteronomic law. Two coerced women appear in consecutive chapters with inverted dispositions: the captive of war must be released — ve-shillaḥtah le-nafshah, "you shall send her away to her own soul" (Deut 21:14) — while the violated na'arah may never be released — lo yukhal shallḥah kol yamav (Deut 22:29). Both verses are marked by the same term for the harm done. I trace how the exegetical tradition handles this asymmetry: the Ramban indexing permission to the pathology it concedes; the Netziv (R. Naftali Zvi Yehuda Berlin, 1816– 1893) developing an account of the temporal asymmetry of coercion and a categorical refusal of victim-blaming; and the Ra'aya Meheimna at Zohar III 277a–b converting the irrevocable bond into a theology of divine nonabandonment by means of the mashal, which it names as its own method.

Clinical argument: Four elements of the Deuteronomic apparatus have direct clinical analogues that are largely absent from contemporary practice: (1) interposition — a mandated interval between desire and action, against a clinical culture of eleven-second agenda-setting and pathway-determined decisions; (2) compelled witnessing — the licensed party legally obliged to be present to the grief he caused and forbidden to interrupt it; (3) temporal asymmetry of consent — the principle that an encounter beginning in coercion is not retroactively purified by subsequent endorsement, which speaks directly to the well-documented phenomenon of retrospective approval of involuntary treatment; and (4) two distinct obligations of release — one requiring discharge without residual claim, one forbidding discharge altogether. Knowing which of these two governs a given patient is, I argue, a substantial fraction of clinical ethics.

Caution: I argue against the temptation to attribute modern trauma theory to pre-modern exegetes, and against the parallel temptation — structurally identical — by which the clinical case report sublimates a patient into a teaching point. The paper closes by proposing the Netziv's ve-la-na'arah lo ta'aseh davar as a limit on interpretive appropriation in both domains.

The Bird's Nest Metaphor II: The Chicks Who Remained

2026-09-06T13:12:00+02:00

A previous study traced the commandment of shiluach ha-ken (Deuteronomy 22:6–7) from biblical law through rabbinic controversy into the mystical imagination of the Zohar, and proposed a clinical theology built upon the dialectic of divine presence and absence: the mother bird as Shekhinah, the emptied nest as exile, and therapeutic tzimtzum as the clinician's disciplined contraction that makes room for the patient to emerge [1]. That essay followed the mother. The present essay reverses the direction of attention and remains with the chicks.

The decisive textual opening is Tikkunei Zohar, and the sixth tikkun, which is largely given over to elaborations of the Shekhinah as bird: mother sheltering her offspring, mother driven from a ruined nest, mother wandering with and without her young. What distinguishes this stratum from both the biblical and the classical rabbinic material is that the suffering is doubled. The mother is chased away and the children cry out. The cry of the fledglings is not decorative. In the narrative logic of the sixth tikkun, it is the cry that ascends, that is carried upward through the graded worlds, and that finally compels a response within divinity itself.

This essay develops the theological and clinical consequences of that doubling. It proposes, as an explicitly constructive rather than philological move, that the patient occupies two positions in the nest simultaneously: chick and tzaddik. As chick, the patient is dependent, exposed, and vocal in registers that precede coherent speech. As tzaddik — understood in the sefirotic sense of Yesod, the channel, rather than in the colloquial sense of moral perfection — the patient becomes the conduit through which repair passes. The Shekhinah, correspondingly, appears as Mother-God: not an omnipotent maternal rescuer substituted for an authoritarian paternal deity, but a maternal presence who is herself exiled, bereaved, searching, and in some measure dependent upon the cry she receives.

Five bodies of scholarship discipline the argument. Erich Neumann supplies the ambivalence of the maternal archetype — containment and engulfment, womb and tomb — and, in his long-unpublished Jewish writings, an explicit attempt to read Kabbalah and Hasidism as a corrective to what he regarded as the anti-feminine bias of normative Judaism. Elliot R. Wolfson prevents any naive celebration of a recovered "divine feminine" by demonstrating the androcentric architecture within which kabbalistic gender symbolism operates. Eitan P. Fishbane licenses attention to the verbs of the bird imagery — hovering, wandering, chirping, fledging — as themselves theological. Daniel C. Matt models the refusal to exhaust a symbol by explaining it. Moshe Idel authorizes the move from symbol to theurgy, in which human action participates in the configuration of the divine world rather than merely contemplating it.

The resulting model displaces the picture of a healer acting upon a passive sufferer. The Mother shelters the chick; the cry of the chick summons the mother. The patient needs the Shekhinah; the exiled Shekhinah, in the strange grammar of this literature, needs the patient. Healing is accordingly reconceived not as unilateral cure but as relational tikkun — a repair in which both parties are altered, and neither is required to disappear.

To Enter Without Disappearing Ambivalence, Value, and Continuity in the Modern Jewish Self

2026-09-06T13:37:52+02:00

The modern Jewish encounter with European civilization is usually narrated as a contest between fidelity and betrayal, with assimilation cast as moral failure and continuity as moral achievement. This essay argues that the framing is wrong, and that its wrongness has consequences we are still paying for. Drawing on Jacob Katz, Arthur Hertzberg, Zygmunt Bauman, Steven Aschheim, Shulamit Volkov, David Sorkin, Todd Endelman, Michael Herzfeld, and Jonathan and Daniel Boyarin, I reconstruct assimilation not as a defect of loyalty but as a structurally induced ambivalence: the predictable psychological residue of an emancipation contract whose terms were never fully written down.

I then press a second question that the historiography tends to leave unasked. Granting that Jewish continuity is desirable, what makes it desirable? PostHolocaust survivalism answered by making continuity self-justifying, and in doing so risked handing the antisemite authorship of Jewish identity.

Contemporary “continuity” discourse inherited that structure and largely secularized it into demography. I argue instead for a value-first account: a tradition earns transmission by the quality of attention it forms in those who receive it, and Jewish continuity is worth wanting because the interpretive discipline it produces is worth having — a claim I test against my own clinical hermeneutics.

The essay closes with the Soloveitchikian figure of ger ve-toshav, stranger and resident, read not as a problem awaiting resolution but as the permanent structure of a mature modern Jewish self, and with the Jungian and Neumannian claim that the visibly traditional Jew and the acculturated Jew function as each other’s shadow rather than as each other’s refutation.

The Third Grammar An Anti-Theodicy for the Clinical Encounter

2026-09-06T18:04:45+02:00

Background: Clinicians who work at the far edge of neurological and oncological illness are repeatedly asked, explicitly or by implication, to account for the absence of God in catastrophe. Two intellectual traditions offer competing accounts. Heretical Kabbalah and its Hasidic descendants — the Sabbatian doctrine of redemptive descent, Izbica determinism, and the wartime writings of the Piaseczna Rebbe — make catastrophe intelligible by making it necessary. Archetypal psychology — Jung's Answer to Job, Neumann's dark Shekhinah, Kirsch's Jewish Jungianism, and Hillman's pathologizing — makes catastrophe intelligible by making it impersonal.

Objective: To adjudicate between these two systems as frameworks for the care of suffering patients, and to propose an integrated alternative that survives Elliot Wolfson's apophatic critique without inheriting its clinical silence.

Methods: A hermeneutic and comparative analysis in the tradition of hermeneutic medicine, drawing on primary kabbalistic and analytic sources, contemporary scholarship, and the author's published corpus in clinical theology.

Findings: The two systems are structurally isomorphic. Both confer meaning by relocation — the first relocates suffering into a cosmic sequence, the second into a transpersonal figure — and both therefore purchase intelligibility with the same coin: the singularity of the sufferer. Wolfson's apophatic acosmism correctly defeats both, but at the cost of dissolving the addressee, leaving the bedside without a second person to speak to.

Proposal: A third grammar is offered, governed by three rules: detachability (a therapeutic practice may be offered at the bedside only if it can travel without the metaphysics that makes the patient's suffering necessary); irreducible antinomy (personal address and impersonal ground are held unsynthesized rather than reconciled); and indexicality (the divine name is used deictically, marking a place rather than describing a being, and is never predicated of the wound itself). Five clinical disciplines and a table of permitted and prohibited utterances follow.

Conclusion: Neither heretical Kabbalah nor archetypal psychology should be brought intact to the bedside. What survives both is not an explanation but an interval — the gap between the patient's cry and the clinician's incapacity, which neither party manufactures and neither may fill.

The Hands and the Face Detachability and the Brother I Did Not Want to See

2026-09-06T18:13:10+02:00

This essay adjudicates between two working drafts that were made to be joined and would not join and completes the adjudication with a mechanism drawn from a paper of my own that appeared to belong to another field altogether. The first draft treats Erich Neumann's collective Shadow and the trajectory of genocide after Auschwitz; the second reads Jacob's disguise, Isaac's blind hands, and the night at the Jabbok; my own paper explains why rabbinic culture took Greek drugs and instruments and declined the humours, the tripartite soul, and the teleological demiurge. The quarrel between the two drafts runs in three registers — a categorical method against the irreducible face, retrospective wisdom against a living recoil, and divine hiddenness as covenantal event against concealment as the constitutive condition of a world — and the third paper resolves all three by supplying a mechanism: detachability.

A remedy travels alone; a system arrives with its theology. Six claims carry the argument.

First, an archetypal grammar may describe the operation a persecutor performs upon persons and may never describe the persons; the Genesis material is the brake this rule requires, and Sandmel's bar against both false parallels and false absences is the evidentiary discipline that goes with it.

Second, assimilation and scapegoating are opposite poles of one axis, since both abolish distinction — one erasing the boundary between Jew and gentile from within and by choice, the other erasing the boundary among Jews from without and by decree; the assimilationist's wish was granted in the wrong currency.

Third, emancipation was a detachability wager that failed twice over: the goods were bundled, and the buyer was not the party competent to decide what travelled alone.

Fourth, the standard resolution of the assimilated Jew's ambivalence toward the Ostjude — that Auschwitz collapsed the distinction and voided it — is a resolution donated by the murderer, and I withdraw it.

Fifth, tzimtzum and hester panim belong to different grammars, ontological and covenantal, held together on the Maimonidean precedent of two criteria in one skull without synthesis; the Chabad ordering in which withdrawal precedes sin permits both without allowing either to console.

Sixth, genocide's decisive step is jurisdictional rather than rhetorical — the manufacture of a person about whom the law has been made silent — which is what the psychology of projection underdescribes.

A central section asks what has become of the archetypal engine Jung named Wotan in 1936: deterritorialized, leaderless, mechanically amplified and far faster, while the grammar it drives is unchanged and its vocabularies have merely rotated.

The essay closes at Peniel, where reconciliation is one meeting of faces, two separate roads, and a limp; and at the covered blood, which the crematoria were built to prevent from crying.

Archetypal Projection, Assimilation and the Limits of Unitive Vision after 1945

2026-09-06T18:21:09+02:00

Erich Neumann’s two-volume *The Roots of Jewish Consciousness* (written 1934–1945 in Tel Aviv, published 2019) remains the most sustained attempt by a first-generation Jungian to construct a specifically Jewish depth psychology during the Shoah. This essay reviews Neumann’s central thesis— the modern Jew’s alienation from direct revelation, the dynamics of archetypal projection that cast the Jew as Europe’s “Other,” and the self-hatred that arises when the assimilationist internalizes that projection. It examines the work’s distance from C. G. Jung, its initial proximity to Martin Buber, and the decisive post-1945 rupture with Buber’s romantic Hasidism, marked by the deliberate excision of a 36-page section on evil as the lowest level of good. An addendum analyses Neumann’s earlier monograph *Jacob and Esau*, comparing it with biblical scholarship and the perspectives of Kirsch, Drob, Hillman, and Avivah Zornberg. Contemporary reflections on Viennese assimilation, the agony of visible Jewishness, and post-Holocaust antitheodicy illustrate the continuing force of Neumann’s diagnosis.

Ab Initio Whole Cell Kinetic Model of Multi-strain Corynebacterium glutamicum (cglTY26)

2026-09-09T17:25:13+02:00

Corynebacterium glutamicum is an industrially important bacterium widely used in amino acid production. In metabolic engineering, metabolic models such as constraint-based genome scale models (GSMs) and kinetic models (KMs) can be useful computational tool guide the rational design of genetic modifications to optimize production of desired compounds in the microbe. Compared to GSMs which emphasis on steady-state flux distribution, KMs enable a comprehensive dynamic visualization of the metabolic network, by simulating the rate of change of metabolite concentration. A recent whole cell kinetic model of Corynebacterium glutamicum ATCC 13032, cglPS26, has been published. Hence, this study aims to expand cglPS26 into a multi-strain model, cglTY26, contained 1109 metabolites, 511 enzymes and their corresponding transcription and translation processes, and 1195 enzymatic reactions. This model provides a useful toolkit for further refinement, experimental validation, and future applications in metabolic engineering.

Seroprevalence of Hepatitis E Virus in Pregnant Women in Brazzaville, Republic of the Congo: Sociodemographic Profile and Frequency of Infection

2026-09-09T17:36:26+02:00

Background: Hepatitis E is an emerging infection of concern in pregnant women, with maternal mortality reaching 20 to 25% in the third trimester. In the Republic of the Congo, no data existed on the seroprevalence of hepatitis E virus (HEV) in pregnant women.

Objective: To describe the sociodemographic characteristics of pregnant women in Brazzaville and to determine the frequency of HEV infection in this population.

Methods: A cross-sectional analytical study conducted from January to October 2025 across eight healthcare facilities in Brazzaville. Two hundred and three pregnant women were enrolled. Anti-HEV antibodies (IgG and IgM) were detected by rapid immunochromatographic test (HEV IgG/IgM Rapid Test Cassette, Biopanda), and viral RNA by RT-PCR (NZYtech Kit) in all participants.

Results: The mean age was 27 ± 7 years; the 20–29 age group predominated (54.7%). The majority lived in cohabitation (75.9%), had secondary education (59.6%), and were unemployed (44.8%). The overall frequency of HEV infection was 19.7% (95% CI: 14.3–25.6). IgM were positive in 5.4%, IgG in 14.8%, and viral RNA detected in 6.9% of participants.

Conclusion: The frequency of HEV in pregnant women in Brazzaville is 19.7%, placing the capital in an intermediate endemicity zone. These unprecedented data underscore the need to integrate HEV screening into routine prenatal care in the Republic of the Congo.

Targeting Mitochondrial-Endoplasmic Reticulum Contact Sites (MAMs) Bioenergetics to Prevent Myocardial No-Reflow: A Non-Equilibrium Thermodynamic Framework

2026-09-09T17:50:31+02:00

Despite high procedural success rates in primary percutaneous coronary intervention (PCI), acute myocardial infarction remains heavily burdened by the « no-reflow » phenomenon and progressive microvascular obstruction [1, 2]. Current pharmacological strategies fail to address the underlying biophysical failure occurring at the microvascular-cardiomyocyte interface. In this paper, we formulate a non-equilibrium thermodynamic and information-theoretic framework centered on the bioenergetic integrity of Mitochondrial-Endoplasmic Reticulum Contact Sites (MAMs) [1, 7]. Under acute ischemia-reperfusion stress, the uncoupling of the IP3R-GRP75-VDAC1 macromolecular complex triggers runaway cytosolic and mitochondrial calcium overload (J_Ca²⁺), driving massive local entropy production (σ_ent) and mitochondrial permeability transition pore (mPTP) opening [1, 3]. By modeling intracellular signaling fidelity through Shannon channel capacity and cellular Signal-to-Noise Ratio (SNR_bio) [4, 5], we quantify the critical thermodynamic threshold (SNR_crit) below which endothelial and myocardial restorative signaling collapses into stochastic oxidative noise [5, 8]. We demonstrate that pre-reperfusion metabolic stabilization via nano-vectorized lipid carriers quenches oxidative entropy, maintains MAM architecture, and preserves channel capacity (C > 10 bits · s⁻¹), thereby preventing microvascular spasm, capillary plugging, and infarct expansion [8, 9, 10]. This Science 4.0 framework bridges cellular non-equilibrium thermodynamics with bedside interventional cardiology [5, 10].

Patterns of Clinical Presentation and Radiological Findings in Patients with Haemorrhagic Stroke Reviewed by the Neurosurgery Service at a Tertiary Hospital in Southern Nigeria

2026-09-10T02:49:28+02:00

Background: Haemorrhagic stroke (HS) carries disproportionate mortality in sub-Saharan Africa, where hypertension is highly prevalent and often inadequately controlled. Understanding the clinical and radiological profile of HS patients referred for neurosurgical evaluation is essential for guiding prevention and resource allocation.

Objective: To describe the demographic characteristics, clinical presentation, risk factor profile (with emphasis on hypertension), and computed tomography (CT) findings of patients with non-traumatic HS reviewed by the neurosurgery service at Rivers State University Teaching Hospital, southern Nigeria.

Methods: This retrospective cross-sectional study included consecutive patients with CT-confirmed, non-traumatic HS reviewed by neurosurgery over 12 months (March 2025 – February 2026). Patients managed solely by neurologists without neurosurgical consultation were excluded. Data on demographics, risk factors, symptoms, examination findings, CT features, ICH score, and WFNS grade were analysed using descriptive statistics.

Results: Sixty-two patients were included (56.5% male; mean age 53.4 ± 11.5 years). Hypertension was the dominant risk factor, documented in 79.0% of the cohort and 96.1% of patients with recorded blood pressure status. Loss of consciousness (72.6%) was the most common presenting symptom. The mean admission Glasgow Coma Scale score was 8.8 ± 3.7, with 50.8% of patients presenting with severe impairment (GCS 3–8). On CT, deep hypertensive-type haemorrhages predominated: capsuloganglionic/basal ganglia (33.9%) and thalamic (27.1%). Intraventricular extension occurred in 58.1% and hydrocephalus in 38.7%. Disease severity was objectively high: among 50 patients with a calculated ICH score, 18 (36.0%) scored 3 or 4, indicating high predicted mortality; among 30 patients graded on the WFNS scale, 25 (83.3%) presented in poor grade (WFNS 4 or 5). In-hospital mortality was 32.3%.

Conclusion: Patients with haemorrhagic stroke referred to the neurosurgery service in our centre present with profound neurological compromise, as reflected by low admission GCS, high ICH scores, and predominantly poor WFNS grades. Hypertension remains the overwhelming modifiable risk factor. These findings underscore the urgent need for community-based hypertension control programmes and strengthened neurosurgical critical care capacity in southern Nigeria.