Mesothelioma “malignant mesothelioma” is a form of cancer that develops from the mesothelium which is the lining membrane for several body cavities.
The most common site for mesothelioma is the pleura.
Mesothelioma is considered as a rare cancer in spite of the higher incidence rate in the last years.
Causes of mesothelioma:
Asbestos inhalation is the most common cause of mesothelioma, asbestos has strong resistance to heat, chemical and electrical factors so it may be used in fireproofing, fire blankets, pipe insulation, plaster ...... etc. Diagnosis of mesothelioma:
It is very difficult to diagnose mesothelioma as the symptoms are similar to many other diseases starting with flu like symptoms then chest pain, fatigue and shortness of breath.
History: Working with asbestos for long period is a major risk factor so history is of great importance in diagnosis of mesothelioma.
Imaging: x-raying, MRI’s, CT scans are commonly used to exclude mesothelioma or to require further tools as biopsy.
Biopsy: taking a sample from tissue or fluid to be examined by pathologist can confirm the diagnosis effectively.
As any type of cancer, mesothelioma treatment in early stages has better prognosis.
Surgery: Surgical treatment includes three main types: diagnostic, curative and palliative surgery.
Pleurectomy is the most common surgery in which the lining of the chest is removed.
Radiation: radiation has the least side effects, external beam radiation is the most common and the most effective radiation therapy for mesothelioma.
Chemotherapy: Alimata and Cisplatin interfere with the cell division process.
Female Lutzomyia is a genus of "sand flies" which is responsible for the transmission of leishmaniasis and other diseases like Carrion's disease.
Only females suck blood, and they produce some hundreds of eggs, which are deposited in dark, humid places, like under stones and rotten leaves. After 2-3 months, they develop through 3 larval instars and pupate, then become adults, they usually move by short flights, and only bite parts of the body not covered by clothes.
Life cycle:- In Man:-
1- the promastigotes enter the blood through the Female Lutzomyia
2- Macrophages phagocytoze the promastigotes
3- Progmastigotes converts into amastigotes
4- multiplying by simple division
In Female Lutzomyia:-
1- Female Lutzomyia ingest the infected cell with amastigotes
2- Amastigotes converts into promastigotes in the luzomyia
Symptoms and pathology:-
Leishmania braziliensis produces mucocutaneous leishmaniasis, characterized by lesions near mucosal membranes. The initial site if infection is a small red papule that ulcerates in a few weeks. The lesions are flat (no raised rim) and often oozing. Infections of the ear, nose and mouth area lead to degeneration of the cartilage and soft tissues, resulting in disfigurement. Spread is either direct or metastatic through lymphatic or blood The most serious form of the disease, called Espundia, can be fatal.
Miltefosine is showed high efficacy specifically against mucocutaneous cases caused by L.brasiliensis in the clinical trials in Colombia.
Poisons are substances that can cause disturbances to organisms, usually by chemical reaction or other activity on the molecular scale, when a sufficient quantity is absorbed by an organism.
Initial management for all poisonings includes ensuring adequate cardiopulmonary function and providing treatment for any symptoms such as seizures, shock, and pain. If the toxin was recently ingested, absorption of the substance may be able to be decreased through gastric decontamination in addition to that some poisons have specific antidotes.
An extracorporeal medical procedure is a medical procedure which is performed outside the body.
Although intoxication is a common problem in adult and pediatric medicine, serious morbidity is unusual. In 2004, only 3% of all toxic exposures reported to the Toxic Exposure Surveillance System of the American Association of Poison Centers were treated in an ICU and in only 0.05% extracorporeal treatment was needed.
Indications of extracorporeal elimination:-
The treatment of intoxication with an extracorporeal technique is justified if elimination of the toxin can be increased by 30% or more using an extracorporeal technique.
Extracorporeal elimination of poisons is used if there are signs of severe toxicity as:
1- Ingested quantity associated with severe toxicity.
2- Ingestion of a toxin with serious delayed effects.
3- Natural removal mechanism impaired.
4- Clinical condition deteriorating.
5- Clinical evidence of severe toxicity: hypotension, coma, metabolic acidosis, respiratory depression, dysrhythmias or cardiac decompensation.
During hemodialysis, toxins and other substances are cleared from the blood by diffusion across a semipermeable membrane down a concentration gradient from blood into dialysate. In order to be removed by hemodialysis, the toxic substance must be water soluble and must have a low molecular weight, low protein binding and a low volume of distribution.
The clearance of a toxic substance depends on membrane surface area and type, as well as on blood and dialysate flow rates. The larger the membrane surface, the greater the amount of toxin removed. Newer high-flux membranes can also remove high-molecular weight substances. Increasing blood and dialysate flow rates can increase the concentration gradient between blood and dialysate, thus optimizing the rates of diffusion and elimination. The major drawback of hemodialysis is the risk of rebound toxicity after cessation of the treatment, due to redistribution of the toxin.
The principle of hemodialysis is the same as other methods of dialysis; it involves diffusion of solutes across a semipermeable membrane. Hemodialysis utilizes counter current flow, where the dialysate is flowing in the opposite direction to blood flow in the extracorporeal circuit. Counter-current flow maintains the concentration gradient across the membrane at a maximum and increases the efficiency of the dialysis.
Fluid removal (ultrafiltration) is achieved by altering the hydrostatic pressure of the dialysate compartment, causing free water and some dissolved solutes to move across the membrane along a created pressure gradient.
"figure "1" for Hemodialysis from wikipedia"
Hemoperfusion is a medical process used to remove toxic substances from a patient's blood. The technique involves passing large volumes of blood over an adsorbent substance. The adsorbent substance most commonly used in hemoperfusion is resins and activated carbon.
During hemoperfusion, the blood passes through a cartridge containing a sorbent material able to adsorb the toxin. There are three types of sorbents: charcoal based sorbents, synthetic resins and anion exchange resins. In order to be removed by hemoperfusion, the toxic substance must have binding affinity to the sorbent in the cartridge and a low volume of distribution. Charcoal efficiently removes molecules in the 1000–1500 kDa range, but does not remove protein-bound molecules. Resins are more effective in the removal of protein-bound and lipid-soluble molecules. Despite their efficacy, the use of hemoperfusion cartridges has declined over the last 20 years, due to limitations of their indications and shelf life. Moreover, hemoperfusion is technically more difficult to perform than hemodialysis, and lacks the possibility of correcting acid–base, fluid and electrolyte abnormalities.
As in dialysis, in hemofiltration one achieves movement of solutes across a semi-permeable membrane. However, solute movement with hemofiltration is governed by convection rather than by diffusion. With hemofiltration, dialysate is not used. Instead, a positive hydrostatic pressure drives water and solutes across the filter membrane from the blood compartment to the filtrate compartment, from which it is drained. Solutes, both small and large, get dragged through the membrane at a similar rate by the flow of water that has been engineered by the hydrostatic pressure. So convection overcomes the reduced removal rate of larger solutes (due to their slow speed of diffusion) seen in hemodialysis.
4- Molecular adsorbent recirculating system:
MARS is a blood purification system, aimed at removing albumin-bound toxic molecules. It consists of three serial extracorporeal circuits: a blood circuit, an albumin detoxification circuit and a hemodialysis circuit. The patient’s blood passes the blood compartment of a high-flux dialyzer, where albumin flows through the dialysate compartment in a countercurrent fashion. Protein-bound and water soluble substances can enter the albumin circuit by means of diffusion. The albumin circuit contains two filters, an activated charcoal filter which absorbs the toxins and an anion-exchange resin filter to cleanse the albumin. Finally, the albumin passes through the blood compartment of a second dialyzer, where small molecules are filtered down a concentration gradient to bicarbonate dialysate. Although the efficacy of MARS in the removal of protein-bound drugs such as diltiazem, phenytoin and theophylline has been demonstrated in case reports, the use of MARS is limited by its availability, technical applicability and high costs.
1- Poison at Dorland's Medical Dictionary. 2-Anne-Corne´ lie J.M. de Pont," Extracorporeal treatment of intoxications". 3-Abel, J. J., Rountree, L. G., and Turner, B. B. The removal of diffusible substances from the circulating blood by means of dialysis. Tn. Assoc. Am. Phys., 28:51, 1913. 4-Feinfeld DA, Rosenberg JW, Winchester JF. Three controversial issues in extracorporeal toxin removal. Semin Dial 2006; 19:358–362. 5-Palmer BF. Effectiveness of hemodialysis in the extracorporeal therapy of phenobarbital overdose. Am J Kidney Dis 2000; 36:640–643. 6- Tan HK. Molecular adsorbent recirculating system (MARS). Ann Acad Med Singapore 2004; 33:329–335.-
Background: Swine flu is an influenza virus which spreads from person to person and can be mutated easily.
New vaccines have been developed to protect people against Swine flu and in these papers we measure the attitude of medical professionals toward these vaccines.
Methods: Using open questionnaire for medical professionals from different countries and ages we asked them about their opinion about the new vaccines and we analyzed these opinions carefully.
Results: 68% refused the vaccine, 23% accepted it and 9% are fair.
Conclusion: Most of the medical professionals refuse the vaccine due to different causes which are discussed in details in this study.
It is a new influenza virus causing illness in people; this new virus was first detected in people in the United States in April 2009. This virus is spreading from person-to-person worldwide, probably in much the same way that regular seasonal influenza viruses spread. On June 11, 2009, the WHO signaled that a pandemic of 2009 H1N1 Flu was underway. (CDC “2009 H1N1 Flu ("Swine Flu") and You” …)
Spread of 2009 H1N1 virus is thought to occur in the same way that seasonal Flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with Flu viruses on it and then touching their mouth or nose. (CDC “2009 H1N1 Flu ("Swine Flu") and you” …)
Once exposed, it can take up to seven days before an individual shows any symptoms. (David L. Miller, Swine Flu general information …)
Swine Flu emergency warning signs:- Children:-
Fast breathing or trouble breathing, Bluish or gray skin color, not drinking enough Fluids, severe or persistent vomiting, not waking up or not interacting, being so irritable that the child does not want to be held and Flu-like symptoms improve but then return with fever and worse cough.
Difficulty breathing or shortness of breath, Pain or pressure in the chest or abdomen, sudden dizziness, confusion, sever or persistent vomiting and Flu-like symptoms improve but then return with fever and worse cough. (Lesley Clinton , sugar and land magazine … )
Patients of Swine Flu should stay home as much as possible, drink plenty of water and take non-aspirin pain relievers for general body aches and pains. (David L. Miller, Swine Flu general information …)
Swine Flu vaccination can be live attenuated nasal spray or inactivated Flu shot, the vaccination is proposed to reduce morbidity, mortality, transmission of the disease. (Vaccination strategies against pandemic H1N1 2009 …)
Because initial supplies are limited, the first shipments of the H1N1 Flu vaccine will be used to vaccinate people in the priority groups like pregnant women, household contacts and caregivers for children younger than 6 months of age, healthcare and emergency medical services personnel, all people from 6 months to 24 years of age and persons aged 25 through 64 who have health conditions associated with higher risk of medical complications from the Flu. (Denise O’Farrell, Volunteers Needed at H1N1 (Swine Flu) Mass Vaccination Clinics …)
Recently after the development of the vaccine against Swine Flu, the public are confused about to take or not to take this vaccine so we are interested in answering this question through asking it for doctors and medical students to take their opinions about this new vaccine.
We searched for the best place where we can find doctors and medical students from different countries, ages, cultures and we find that the medical pages are the best way to reach them and we chose the best two medical pages in the internet “Doctors”, “Faculty of medicine” which contains more than 70.000 members.
Questions of study:-
1- What is the degree of acceptance or refuse to the vaccine among doctors and medical students?
2- What are the causes of accepting or refusing it?
Aim of study:-
1- To measure the degree of acceptance or refuse to the vaccine among doctors and medical students.
2- To study the causes of accepting or refusing the vaccine.
3- To provide the public with medical advice about the vaccine.
It is an analytical study to analyze the opinions of doctors and medical students about the vaccination against Swine Flu.
We asked the members in the page Faculty of medicine about their opinion about vaccination against Swine Flu, after excluding the inappropriate answers we collected the first 250 answers only to be studied as expert non proportional sample.
It is an analytical study.
This study extends from October to September 2009.
We analyzed these opinions into categories according to accepting or refusing the vaccine.
We asked the members about their opinion about the vaccination against Swine Flu virus and we collected more than 300 answers then we started to exclude some of them according to these instructions:
1-As the question was in English, Non English answers are excluded.
2-Unclear answers which can’t be understood are excluded.
3-Answers which have no relation to the question are excluded.
4-Answering with another question is excluded.
After excluding these answers we chose the first 250 answers only to be analyzed into three major categories (Agree – Disagree – Fair) then we analyzed these major categories into subcategories according to the factors and reasons affecting it.
Results was unpredictable with high percentage for who refuse the vaccine in comparison with who accept it as figure “1” shows.
(Figure”1” opinions of the members about Swine Flu vaccine)
Factors affecting acceptance:-
23% from the members accepted the vaccine, most of them see that it is better than no thing, they aren’t confirmed if it is effective or not but they should take it for different reasons as:-
1- Protection is better than treatment.
2- The vaccine is safe especially the killed one and if it has any complications it will be less dangerous than the virus itself.
3- The virus is more dangerous than the seasonal Flu so we must take our precautions.
4- As they are doctors they are high risk group and they have a role in the community in preventing the transmission of the disease as if they become sick with Swine Flu they will transmit it for their patients.
(Figure”2” Factors affecting acceptance)
Factors affecting refuse:-
68 % from the members refused the vaccine and it is very high percentage due to different reasons as:-
1- Unnecessary, the virus is not dangerous and has very low mortality rate in spite of its high incidence rate.
2- Dangerous, it has many side effects and it may be carcinogenic and doctors don’t know what it contains.
3- It is business from the pharmaceutical companies they scare people from the virus to sell it more.
4- Not tested well and needs more studies and verifications.
5- Ineffective, the virus is mutating which may cause resistance.
6- Other precautions as improving our immune system by vitamins and minerals in addition to masks … etc are better.
7- Unclear causes.
(Figure”3” Factors affecting refuse)
Factors affecting being fair:-
23% from the members are fair can’t accept the vaccine or refuse it, they have mixed feeling concerning the vaccine as they see some advantages and disadvantages for it but some of them advise by giving the vaccine for immunocompromised and who have low immunity only.
(Figure”4” Factors affecting being fair)
As we mentioned before we analyzed the members’ opinions and most of the members refuse the vaccine strongly in spite of the great propaganda by the pharmaceutical companies and some governments.
Some of them refused it as they see that it is apart from the pharmaceutical war and some refused it as it is ineffective, unnecessary, dangerous, and not tested well.
Although some governments request the vaccination urgently, 170 from 250 of the professionals refuse it and ask their patient to avoid it.
Some thing here is unclear, pharmaceutical companies, TV, magazines ask people to be vaccinated but doctors refuse it.
Public now are confused, they don’t have sufficient information or experience to judge about the vaccine.
After asking the doctors and medical students about their opinion about the vaccination against Swine Flu 68% from them refuse it and advice not to take it, 23% from them accept the vaccine in addition to 9% who are confused and can’t advice with taking or not taking the vaccine.
1- Testing the vaccine again and confirming its contents.
2- Testing the vaccine again and confirming its efficacy.
3- Establishment of awareness raising campaigns
1- Centers for disease control and prevention, “2009 H1N1 Flu ("Swine Flu") and you”.
2- David L. Miller, Swine Flu general information 2009.
3- Lesley Clinton, sugar and land 2009.
4- European vaccination strategies against pandemic H1N1 2009.
5- Denise O’Farrell, Volunteers Needed at H1N1 (Swine Flu) Mass Vaccination Clinics 2009.