Thursday, October 17, 2013

BITES AND STINGS

Bites and stings can occur from a wide variety of insects, reptiles, animals, and even humans. Most are not serious and cause only minor swelling, redness, pain, and itching.

In general, care for bites and stings by washing the site with soap and water. As a precaution, always remove jewelry from the affected area. Apply an antibiotic ointment and covert the area with an adhesive bandage or pad. Except for snakebites, use local cooling to reduce swelling and pain.

Some bites and stings are more serious and can benefit from first aid care. This is especially true for individuals who are very young or old, or have existing medical issues. Venomous bites and stings inject venom, or poison, into the body. Focus on slowing the absorption of venom into the body and quickly activating the EMS system for specialized treatment.

HUMAN AND ANIMAL BITES

Human and animal bites can cause significant injury and bacterial infection. Bites from animals such as raccoons, skunks, bats, and foxes can also cause rabies. Left untreated, rabies is fatal.

Control any bleeding with direct pressure. Wash the bite and flush with large amounts of water. Seek professional medical attention.

TICK BITES

Ticks are blood-feeding insects that are typically found in tall grass and shrubs. The biggest concern with tick bites is the exposure and transmission of infectious diseases.

When a tick bites, it attaches itself firmly to the skin. To remove it, grasp it close to the skin with tweezers or a tick removal tool. Pull straight up with a steady, slow motion. If portions of the tick remain in the skin, seek further medical attention.

Do not use fingernail polish, petroleum jelly, a glowing hot match, or alcohol to remove a tick. These actions have no prove value and may cause additional problems.

SPIDER BITE

Spiders typically inhabit out of the way places such as wood piles or outbuildings. There are certain spiders that can be dangerous to humans. This includes the black widow and the brown recluse.

Initially, venomous spider bites are often difficult to identify. Small puncture marks and bleeding may be seen. Tenderness, swelling, pain, itchiness, and redness at the bite site can develop. Over time, cramping, pain and muscular rigidity in the body may occur. A person may experience fever, weakness, nausea and vomiting, or difficulty breathing.

If you suspect a severe reaction from spider bite may be occurring, activate EMS. Keep the person warm, reassured, and quiet.

SNAKEBITES

Pit Vipers

Venomous pit vipers, such as cottonmouths, copperheads, and rattlesnakes strike once and leave a characteristic bite with single or double fang marks. Pit viper bites can cause an intense, burning pain and local swelling. Swelling may involve the entire limb within hours.

If you suspect a Pit viper bite, have the person sit still and activate EMS. Control any bleeding with a clean pad and direct pressure. Immobilize the injured part and keep it below heart level.

Coral Snake

A venomous Coral snake bite is different than one from a Pit viper. Coral snakes “chew” with fixed fangs. Pain and swelling at the bite site may be minimal or absent. Serious effects are often delayed and can include abdominal pain, nausea and vomiting, rapid heartbeat, difficulty breathing, drooling, and an altered mental state.

If you suspect a Coral snake bite, have the person sit still and activate EMS. To slow venom spread, apply a pressure bandage around the entire length of the bitten extremity. Wrap towards the body. The bandage should be snug, but not so tight that you can’t slip a finger under it. Immobilize the injured part and keep it below heart level. Keep the person warm, reassured, and quiet. Move the person only if needed.

When caring for snakebite, do not apply local cooling. Do not cut through a snakebite wound, apply suctioning, or use a tourniquet. These treatments are not effective and may be harmful.

STINGING INSECTS

Stinging insects such as bees, wasps, and fire ants are normally passive except when in defense of their nests or territories. While wasps and fire ants can sting repeatedly, the stinger of a honey bee detaches from its body, remains embedded in the skin, and continues to inject venom. If a stinger is present in the skin, quickly remove it.

It is possible for a life-threatening allergic reaction to arise. Monitor the person for at least 30 minutes to see if her condition worsens. If the person carries a prescribed epinephrine auto-injector, assist the person with using it.

Bibliography

MEDIC First Aid International, Inc. (2010). BasicPlus CPR, AED and First Aid for Adult Student Guide. USA: MEDIC First Aid.

Monday, September 30, 2013

LEAD POISONING PLUMBISM

Pica

Defined as persistent eating of non-nutritive material for 1 month or more
Always search for lead lines in any child with an ingested foreign body

Main source of lead intoxication is lead paint used in houses painted before 1980
Absorption is greater in children than adults

Lead may be inhaled as well as ingested

Symptoms develop more quickly through GI tract
Toxicity more severe with co-existing iron, zinc, or calcium deficiency

Pathology

Lead concentrates in metaphyses of growing bones

Distal femur
Both ends of tibia
Distal radius leading to

Failure of removal of calcified cartilaginous trabeculae in provisional zone

Clinical findings

Neurological

Learning disability
Decreased IQ
Mental retardation
Encephalopathy
Motor deficits
Seizures
Cerebral edema
Hearing loss

Gastrointestinal

Abdominal pain
Nausea
Vomiting
Diarrhea
Constipation
Anorexia
Metallic taste in mouth
Ileus

Renal

Tubular damage

Azotemia

Gout

Hematologic

Affects blood synthesis
Hemolysis
RBC stippling
Iron deficiency

Musculoskeletal

Muscle and joint pain

Soft tissue

Blue-black line in gum margins

Endocrine

Decreased stature

Decreased growth hormone

Decreased vitamin D levels

Laboratory findings

Predate bone changes on x-ray
Serum Lead Level >1.2 umol/L
Urine lead level elevated
Peripheral Smear

Stippled erythrocytes

Complete Blood Count

Urine microscopy of sediment or renal biopsy

Acid-fast inclusion bodies in tubular nuclei

Pathognomonic for lead poisoning

Free Erythrocyte Protoporphyrin (FEP) > 0.6 umol/L

Imaging findings

Cerebral edema in acute lead intoxication
Particles of lead in GI tract
Bands of increased density at metaphyses of tubular bones (growing bone)

Metaphyses of growing bones may be dense normally

Lead lines more apt to be seen in proximal fibula and distal ulna where growth is not as great as other long bones

Lead lines may persist

Frontal radiograph of both knees of a child with lead poisoning show dense metaphyseal bands
involving not only distal femurs and proximal tibias but proximal fibulas as well

Bone-in-bone appearance
Abnormalities in bone modeling

Erlenmeyer flask appearance to distal femur

DDx (see tables below)
Treatment

Surgical removal of lead foreign bodies in the gut (e.g. dice containing lead) if not eliminated within 2 weeks
Chelation is indicated if the level is greater than 45 mcg/dL even if asymptomatic

First correct iron deficiency

Chelating agents include EDTA, BAL, D-Penicillamine, and Succimer

Lucent Metaphyseal Bands

Normal

Leukemia

Neuroblastoma

TORCH infection

Dense Metaphyseal Bands

Normal

Lead poisoning

Treated leukemia

Healing rickets

retrieved: http://www.learningradiology.com/archives04/COW%20082-Lead%20poisoning/leadpoisoncorrect.htm

Tuesday, September 24, 2013

SUPPORT YOUR HEART

“If you exercise regularly, eat right and don’t smoke, you are on your way to healthier heart”, says Dr. Willet.

Taking a few healthy lifestyle steps can help you feel better and reduce your risk of heart attack and stroke. Here, what you need to know to eat right, get active and quit smoking.

To put the pieces of an ideal heart-healthy eating plan together, “think of diet and nutrition like an orchestra- all components should be balanced for optimal heart health”, says Walter Willett, MD chair of the nutrition department at the Harvard School of Public Health.

EAT FOR YOUR HEART:

To get started, try these six simple steps:

Ø Control your portion size

Fill half a normal dinner plate with green leafy, bright or deeply colored vegetables such as spinach and beets. These veggies are packed with heart-healthy nutrients. Leave a quarter each for lean protein and complex carbohydrates, such as potatoes (no fried), brown rice and whole wheat pasta.

Ø Eat less red meat

It’s high in saturated fat, which boosts cholesterol levels. Instead, choose proteins such as broiled or grilled fish, skinless poultry and beans. Consider eating one meat-free meal a day.

Ø Choose nonfat and low-fat dairy

Opt for skim or soy milk, fat-free yogurt and low fat cheese. Dairy is rich in potassium, which reduce stroke risk, according to recent research.

Ø Fill up on fruits and vegetables

The American Heart Association (AHA) recommends you get at least four to five cups of fruit and the same amount of vegetable daily. One cup is about of woman’s fist.

Ø Favor fiber-filled foods

Fiber-rich foods such as produce and whole grains are satiating- so you may feel fuller longer. Soluble fiber, found in beans, peas, oats, apples, citrus, barley and psyllium, can help lower cholesterol.

Ø Toss the salt shaker

Salt causes fluid retention, which raises blood pressure and can worsen angina. Follow the AHA recommendation of less than 1500 mg a day, unless your doctor suggest otherwise. To reduce salt in your diet, eat more fresh food and fewer processed products, which tend to be loaded with sodium. If you’re out at a restaurant, ask if the chef can prepare low salt versions of menu items for you.

GET MOVING:

Exercise will help make you stronger and increase what’s known as exercise tolerance, how much you can physically exert yourself before becoming exhausted. The better your exercise tolerance becomes, the harder you can work out without experiencing angina pain. Exercise also helps lower blood pressure, cholesterol and blood glucose levels.

Ø Enlist a buddy

Plan to exercise with your spouse, a family member or friends to help you stay committed.

Ø Start slow and build up

“You don’t have to work out like an Olympic athlete”, says Robert Eckel, MD, head of preventive cardiology at the University of Colorado Anschutz Medical Campus in Aurora.

How much exercise is enough to help your heart?

Thirty minutes a day, at least five days a week, of brisk walking is fairly standard. However, if you heart’s sake, your doctor may want you to strive for an hour of physical activity daily. You can break it up into 15 minute chunks.

Ø Log it

Keep track of the time, speed and duration of you walks.

KICK BUTTS

Quitting is essential for anyone who smokes, but it’s especially important for people with angina.

Smoking causes your arteries to constrict, which can make angina worse. Talk to your doctor about tools for quitting. Research shows that combining support and medical therapy is most effective.

Get helpful tips and information….at www.SpeakFromTheHeart.com

Thursday, September 19, 2013

NEW TEST RAPIDLY DISTINGUISHES VIRAL FORM BACTERIAL INFECTIONS

A new test that analyzes patients' immune responses, rather than the pathogens themselves, can rapidly distinguish viral infections from bacterial infections, according to an article published in the September 18 issue of Science Translational Medicine.
If carried into clinical use after further evaluation, the assay could help physicians better decide which patients need antibiotics and avoid inappropriate prescribing of antibiotics to patients who will not benefit.
Aimee K. Zaas, MD, MHS, associate professor of medicine at the Duke Institute for Genome Sciences and Policy, Durham, North Carolina, and colleagues previously reported that they could classify individuals according to respiratory viral infections based on microarray profiles of blood samples — work that has been reproduced by other researchers.
In the current study, the researchers used a Taqman low-density array (TLDA) platform to develop a reverse transcription–polymerase chain reaction (RT-PCR) assay and a predictive algorithm to test the blood of patients presenting with infection symptoms.
To develop the assay, they first tested 17 healthy volunteers who had been inoculated with influenza H3N2/Wisconsin and 24 who had been inoculated with influenza H1N1/Brisbane. They found that using expression data from a relatively small number of genes, they could classify the volunteers at 100% accuracy for H3N2 and 87% accuracy for H1N1.
"The performance of the RT-PCR assay to identify symptomatic versus asymptomatic individuals with experimentally inoculated influenza H1N1 or H3N2 is excellent...with cross-validation highly accurate between influenza subtypes," the researchers write.
They then validated the assay by testing peripheral blood RNA from 102 patients presenting with respiratory infections at Duke University Medical Center; Henry Ford Medical Center in Detroit, Michigan; or Monash General Hospital in Melbourne, Australia. The patients had either microbiologically proven viral respiratory infection or systemic bacterial infection. In this population, sensitivity of the RT-PCR assay was 89% (95% confidence interval [CI], 72% - 98%), and specificity was 94% (95% CI, 86% - 99%).
Ruling in or out
"[T]he viral infection 'score' represents a measure with potential clinical benefit for both 'ruling in' and 'ruling out' viral respiratory infection...with possibilities for improved triage, decreased utilization of inappropriate antibacterial therapy, and guiding judicious use of limited antiviral resources in a pandemic setting," the researchers write.
"It's an approach that could turn out to be very useful clinically, and certainly is likely to help us understand viral infections and how they differ from bacterial infections better," Andrew T. Pavia, MD, chief of the Division of Pediatric Infectious Diseases, University of Utah Health Sciences, Salt Lake City, and an infectious diseases advisor to the Infectious Diseases Society of America, told Medscape Medical News.
"What they've done is to turn the approach to diagnosing viral or bacterial infection around on its head," he continued. "We normally use tests to detect the germ or the pathogen that we're interested in. What they've done is to try and use the pattern of the human response to the infection to tell whether it's a bacteria or a virus. Obviously, that's terribly important, because if we can accurately detect who has a virus, we can avoid excessive antibiotic use and restrict antibiotic use to those people who have a bacterial infection."
Dr. Pavia explained that at this time, even with the most sophisticated devices available, physicians can only detect about 16 different viruses of approximately 30 or 40 that might be causing an illness. "The potential for a test like this, turned into a device, is perhaps it could be cheaper and more efficient. It wouldn't tell you, 'you have influenza B or you have corona virus HKU,' but it could tell you, 'you don't have a bacterial infection and we can spare you the antibiotic exposure.' "

Information from Industry

Early treatment of AFib may stem disease progression

Drs Ellenbogen, Chung, and Calkins discuss the impact of early treatment on disease progression.

View video

In their analysis, the researchers conclude, "[W]e have established a 'proof of concept' that host expression of a relatively small set of genes, as measured by RT-PCR from blood RNA, can be used to classify viral respiratory illness in unselected individuals presenting at an emergency department for evaluation of fever."
"What they've done is pretty efficient," Dr. Pavia said. "But I think there's a lot more confirmatory work that needs to be done. You now have to take this into a more real-world setting looking at a variety of children and adults and prove that it works on other people. You would have to take what they've done, using the RT-PCR TLDA card, not suitable outside a research lab, and develop a convenient device. It's all doable."
This research was supported by the by the Defense Advanced Research Projects Agency, the National Institutes of Allergy and Infectious Diseases, and the Clinical Science Research and Development Service of the Veterans Health Administration. Six authors report filing for a provisional patent on the respiratory viral response signature. Four authors report receiving funding from Novartis. The other authors have disclosed no relevant financial relationships.
Sci Transl Med. 2013;5:203ra126. Abstract

http://www.medscape.com/viewarticle/811219

FISH OIL MAY PROTECTED AGAINST ALCOHOL-RELATED DEMENTIA

Exposure to a compound found in fish oil may protect against the development of dementia in heavy drinkers, new research suggests.
A study presented at the recent Congress of the European Society for Biomedical Research on Alcohol in Warsaw, Poland, examined rat brain cells exposed to alcohol levels equivalent to 4 times the legal driving limit.
Results showed that the cell cultures that were also exposed to omega-3 docosahexanenoic acid (DHA) showed approximately 90% less neuroinflammation and 90% less neuronal brain cell death compared with the cells that were not exposed to the fish oil compound.
"We hypothesized that omega-3 fatty acids, specifically DHA (which has been shown to neuroprotect from other acquired brain insults in the laboratory and to some degree in human studies) would suppress or prevent the neuronal degeneration due to binge alcohol exposure," principal investigator Michael A. Collins, PhD, professor in the Department of Molecular Pharmacology and Therapeutics at the Stritch School of Medicine at Loyola University, Chicago, Illinois, told Medscape Medical News.
"And basically, that is what we found," he added.

Relevant to Humans

Dr. Collins noted that although this was an animal study designed to measure neurodegeneration and related phenomena, and not a study specifically of dementia, "since brain degeneration underlies persistent or permanent dementia, the results were extrapolated to what might happen in humans."
And although he noted in a release that further studies are now needed, "fish oil has the potential of helping preserve brain integrity in abusers. At the very least, it wouldn't hurt them."
In 2011, Dr. Collins and colleagues published a meta-analysis of 143 studies showing that consuming up to 2 alcoholic drinks a day for men and 1 drink a day for women appeared to reduce the risk for dementia and cognitive impairment.
However, "too much alcohol overwhelms the cells," they noted in a release.
"Our previous work and that of others had linked neurodegeneration to 'neuroinflammatory'-like mechanisms that include oxidative stress (oxygen and nitrogen free radicals). The oxidative stress, we suspected, resulted in part from alcohol-induced excessive release of unsaturated fatty acids from brain membranes," explained Dr. Collins.
In the current study, the researchers exposed brain cell cultures from adult rats to heavy amounts of alcohol and then compared half the cells, which were further exposed to omega-3 DHA, with the other nonexposed half.
"Our results indicate excessive arachidonic acid (AA) mobilization due to increased phospholipase A2 (PLA2) levels/activity, and this appears related to elevations in astroglial aquaporin-4 (AQP4) and brain edema," write the investigators.
In other words, excessive drinking can cause higher levels of PLA2 activity, leading to excessive production of AA (a polyunsaturated omega-6 fatty acid), which in turn leads to increased AQP4/neuroinflammation and swelling of the brain.
However, inhibiting AQP4 was found to be neuroprotective to the cells.

Best Protection