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Medical Applications of a Nuclear Reactor
Albert Van de Wiel,
Menno Blaauw
Issue:
Volume 7, Issue 1, January 2019
Pages:
1-4
Received:
12 December 2018
Accepted:
2 January 2019
Published:
31 January 2019
Abstract: Nuclear reactors are usually associated with the production of energy, but some reactors, including the reactor facility of the University of Technology Delft, The Netherlands, are being used for scientific research. This review describes the current possible applications of such a research facility in medicine. This concerns in the first place the production of various nuclides and chemical carriers, which are now widely used in clinical medicine. Both α and β emitters can be effective in the treatment of tumors and metastases, while γ-emission allows imaging of organs and activity of biological processes. A less well-known application of a research reactor is instrumental neutron activation analysis (INAA), a technique for qualitative and quantitative multi-element analysis of major, rare and trace elements in all kinds of materials, including those from human origin such as blood, nails, hair and tissue samples. In contrast to mass spectrometry, INAA is not restricted to measurement in small samples, since even large samples up to kilograms can be analyzed. This is especially of importance when an element is not distributed homogeneously in materials. INAA is also used in biomonitoring to measure the burden of toxic chemical compounds and elements in biological substances. A promising development is the use of enriched stable isotopes, an attractive alternative for the application of radioactive tracers in the study of the bioavailability and distribution of essential trace elements and metals in the human body.
Abstract: Nuclear reactors are usually associated with the production of energy, but some reactors, including the reactor facility of the University of Technology Delft, The Netherlands, are being used for scientific research. This review describes the current possible applications of such a research facility in medicine. This concerns in the first place the...
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Inter-Rater Reliability of ST-Segment Measurement at a University Hospital in Argentina
Ignacio Martín Santarelli,
Diego Costa,
Sandra Swieszkowski,
Ricardo Perez de La Hoz
Issue:
Volume 7, Issue 1, January 2019
Pages:
5-8
Received:
14 December 2018
Accepted:
15 January 2019
Published:
31 January 2019
Abstract: The accurate determination of the electrocardiographic ST-segment elevation in a patient with clinical suspicion of acute coronary syndrome is essential for treatment with urgent myocardial reperfusion. The aim of this study was to determine the inter-rater reliability of ischemic and non-ischemic ST-segment elevation measurement among physicians with different specialties and experience. We performed an observational, cross-sectional study, with a comparative correlation and paired sampling. 56 physicians from a university hospital in Buenos Aires city were included: Cardiologists from the Coronary Care Unit (CCU) and Cardiology Division, Internal Medicine physicians from the hospitalization, ambulatory care and Emergency divisions, and third- and fourth-year Internal Medicine residents. Each participant analyzed 6 electrocardiograms and was asked to determine the magnitude of the ST-segment elevation at the J-point, and the corresponding diagnosis. The inter-rater coefficient was lower than 0.2, and the global kappa coefficient was 0.06 (p < 0.001). The global correct interpretations were: inferior wall myocardial infarction (MI): 89.3%; anterior wall MI: 51.8%; lateral wall MI: 75%; left bundle branch block: 91.1%; left ventricle hypertrophy: 44.6%; acute pericarditis: 25%. We believe that the low correlation was probably due to the difficulty in determining the J-point. These findings could suggest the need to strengthen the electrocardiographic concepts of ischemia, and the differentiation between ischemic and non-ischemic ST-segment elevations.
Abstract: The accurate determination of the electrocardiographic ST-segment elevation in a patient with clinical suspicion of acute coronary syndrome is essential for treatment with urgent myocardial reperfusion. The aim of this study was to determine the inter-rater reliability of ischemic and non-ischemic ST-segment elevation measurement among physicians w...
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Persistent Pulmonary Atelectasis in Patient with Rheumatoid Arthritis Treated with High-Flow Therapy and High-Frequency Chest Wall Oscillation
Anna Annunziata,
Elena Sciarrillo,
Maurizia Lanza,
Giuseppe Fiorentino
Issue:
Volume 7, Issue 1, January 2019
Pages:
9-11
Received:
14 November 2018
Accepted:
31 January 2019
Published:
22 February 2019
Abstract: Rheumatoid arthritis is a systemic inflammatory disorder that affects ∼1-2% of the population. Although a progressive destruction of cartilage and bone is the main presentation, extra-articular manifestations can occur in about 40% of patients during the course of their disease and are associated with significant morbidity and increased mortality. Pulmonary complications can frequently occur in these patients, although not always clinically recognized. We present a case of 60-year-old woman suffering from rheumatoid arthritis came to our department for the presence of exertional dyspnea, cough with poor mucous expectoration, chest pain and worsening of daytime asthenia. At a chest x-ray, evidence of right basal pulmonary atelectasis, for which she had practiced antibiotic therapy with persistence of symptomatology and pulmonary atelectasis. Chest CT showed parenchymal consolidation. The patient was treated with antibiotics and rehabilitation therapy, bronchial endoscopy, with persistence of pulmonary atelectasis. She started nasal high-flow therapy but in the seventh day appears epistaxis. For this reason, she suspended treatment with NHF. At the next rehabilitation session, for the recurrence of epistaxis, an otorhinolaryngology visit was performed that confirms the presence of nasal varices. Therefore, the patient started high-flow therapy with a mouthpiece with the use of High Frequency Chest Wall Oscillation. At the end of rehabilitative treatment we observed clinical and radiological improvement.
Abstract: Rheumatoid arthritis is a systemic inflammatory disorder that affects ∼1-2% of the population. Although a progressive destruction of cartilage and bone is the main presentation, extra-articular manifestations can occur in about 40% of patients during the course of their disease and are associated with significant morbidity and increased mortality. ...
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Oropharyngeal Dysphagia with Aspiration as a Provoking Factor for COPD Exacerbation
Noor Sameh Darwich,
Shamsuddin Chowdhry Pracha,
Natalie Ann Miller
Issue:
Volume 7, Issue 1, January 2019
Pages:
12-14
Received:
6 February 2019
Accepted:
11 March 2019
Published:
26 March 2019
Abstract: The most common provoking factors for chronic Obstructive Pulmonary Disease (COPD) exacerbation include viral and bacterial tracheobronchitis, pneumonia, and exposure to environmental irritants and air pollution. In many patients with COPD exacerbation, the underlying cause cannot be identified. In general, patients with COPD exacerbation get admitted to the hospital and treated with antibiotics, glucocorticoids and inhaled bronchodilators. Oropharyngeal dysphagia is an under-recognized provoking factor for COPD exacerbation. Patients with advanced COPD often have impaired coordination of respiration and deglutition which can lead to aspiration of liquids, food particles, and saliva into the airways. Aspiration events can lead to exacerbation of symptoms and cause further decline in lung function. We described a 69-year-old male with a history of COPD who presented with progressive dyspnea, productive cough and hypoxia which required intubation and mechanical ventilation. The patient underwent a bronchoscopy for airway inspection which showed pieces of meat in the right main bronchus which were removed. Reportedly, the patient was having difficulty swallowing solid food prior to admission to the hospital.
Abstract: The most common provoking factors for chronic Obstructive Pulmonary Disease (COPD) exacerbation include viral and bacterial tracheobronchitis, pneumonia, and exposure to environmental irritants and air pollution. In many patients with COPD exacerbation, the underlying cause cannot be identified. In general, patients with COPD exacerbation get admit...
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Cardiac Arrhythmias in Patients with End Stage Renal Disease (ESRD) on Hemodialysis; Recent Update and Brief Literature Review
Firas Ajam,
Swapnil Patel,
Anas Alrefaee,
Dawn Calderon,
Mohammad A. Hossain,
Arif Asif
Issue:
Volume 7, Issue 1, January 2019
Pages:
22-26
Received:
15 February 2019
Accepted:
25 March 2019
Published:
22 April 2019
Abstract: Cardiovascular diseases remains one of the leading causes of mortality worldwide, and causes more than one millions deaths annually in the United States alone. Patients with chronic kidney disease (CKD) are predisposed to different types of heart rhythm abnormalities including but not limited to atrial fibrillation, atrial flutter, ventricular tachycardia, and ventricular fibrillation. Both cardiovascular diseases and chronic kidney disease (CKD) may cause various variations in the cardiovascular system, autonomic nervous system, and various electrolytes abnormalities that open the door for the occurrence of multiple cardiac arrhythmias. Various pathophysiological mechanisms have been suggested in describing the correlation of cardiac arrhythmias in CKD patients. Despite the substantial progress in the management of chronic kidney disease, cardiovascular complications still highly dominant in CKD patient. Thus, reducing mortality from cardiovascular disease and sudden cardiac death in dialysis is a global health challenge. Management of cardiac arrhythmias includes the use of antiarrhythmic drugs, in addition to the use of catheter ablation and cardiac implantable electronic devices. The present review addresses the correlation between chronic kidney disease and different cardiac arrhythmias, the different pathophysiological mechanisms explaining the high risk of arrhythmias in CKD patients, the diagnostic tools used to identify arrhythmias, and the rule of subcutaneous defibrillators in preventing sudden cardiac death in dialysis patients.
Abstract: Cardiovascular diseases remains one of the leading causes of mortality worldwide, and causes more than one millions deaths annually in the United States alone. Patients with chronic kidney disease (CKD) are predisposed to different types of heart rhythm abnormalities including but not limited to atrial fibrillation, atrial flutter, ventricular tach...
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