Opinion article: the acute radiation syndrome – need for updated medical guidelines

The major immediate and severe medical consequences in man following exposure to high doses of ionizing radiation can be summarized within the concept of the acute radiation syndrome (ARS). In a dose-dependent fashion, a multitude of organ systems can be affected by such irradiation, presenting considerable medical challenges to treating physicians. Accidents or malevolent events leading to ARS can provoke devastating effects, but they occur at a low frequency and in a highly varying manner and magnitude. Thus, it is difficult to make precise medical predictions and planning, or to draw conclusive evidence from occurred events. Therefore, knowledge from on-going continuous developments within related medical areas needs to be acknowledged and incorporated into the ARS setting, enabling the creation of evidence-based guidelines. In 2011 the WHO published a first global consensus on the medical management of ARS among patients subjected to nontherapeutic radiation. During the recent decade the understanding of and capability to counteract organ damage related to radiation and other agents have improved considerably. Furthermore, legal and logistic hurdles in the process of formally approving appropriate medical countermeasures have been reduced. We believe the time is now ripe for developing an update of internationally consented medical guidelines on ARS.

Assessing Baseline Proficiency of National Guard Combat Medics Due for Recertification: A Pilot Study

ABSTRACT Introduction Combat medics, or 68W Healthcare Specialists in the Army, are an early part of a combat casualty’s chain of survival. Their job requires a high degree of competency in emergency medical guidelines established by the Committee of Tactical Combat Casualty Care (CoTCCC) as well as basic bleeding control skills. The American Warfighting Experience for the last two decades highlights just how important these skills are in preventing death on the battlefield. A recent Government Office of Accountability suggests sustainment for critical wartime skills is lacking. This is especially concerning for National Guard Soldiers who must juggle their military obligations with their civilian ones. It is unknown how well-prepared National Guard combat medics are in fulfilling their most critical combat care responsibilities. The current study attempts to address this gap in knowledge by assessing National Guard Soldiers due for their annual recertification. Materials and Methods Nine medics due for their annual recertification were recruited for the study. First, they were given a questionnaire intended to gather basic demographic information about their experience and a six-question quiz on current CoTCCC guidelines. The medics were then evaluated on their ability to place a Combat Application Tourniquet on a live person, which was verified by a Doppler microphone. The medics were finally evaluated on their ability to pack a wound with a hemostatic dressing. Statistical analysis was used to determine if experience or frequency of practice over the previous year could predict success. Results Medics, on average, were only able to answer an average of 2.2 questions on the quiz correctly. The overall success rate for tourniquet application was 44.4%, and the overall success rate for wound packing was 22.2%. Statistical analysis showed that experience or frequency of practice could not adequately explain the success rates. Conclusions A soldier’s experience alone could not predict if the soldier will be successful in performing bleeding control tasks or if they will demonstrate higher levels of casualty care knowledge. Future research is needed in this area to better define recertification and refresher training issues.

Short- and medium-term cost effects of non-indicated thyroid diagnostics: empirical evidence from German claims data

This paper contributes to the discussion of whether non-indicated ultrasound examinations of the thyroid gland contribute to overtreatment and excess health care expenditures. Using two sources of claims data from Germany, we analyzed data from patients who underwent a TSH blood test which is the initial diagnostic measure to check for possible presence of thyroid dysfunction. In a matching analysis, we compared health costs of two groups of patients. One consisted of patients who underwent an early thyroid ultrasound that according to medical guidelines—at this point—was probably not indicated. The other group consisted of patients, who underwent no ultrasound examination at all or later in the course of the disease, making probable a correct indication. Both groups were made comparable by the means of a matching procedure. Average thyroid-specific health costs were substantially higher for the first group in the quarter in which the ultrasound examination took place. Some deviation in these specific costs persisted over a substantial period of time, with drug expenditures exhibiting the biggest difference. If, however, total health costs were considered, difference in costs was only found in the initial quarter. We conclude that non-indicated ultrasound examination of the thyroid gland may have some moderate effects on thyroid-specific costs. Yet the data do not suggest that long-lasting overtreatment and excess health expenditures are initiated by non-indicated ultrasound in Germany.

Paramedics’ knowledge of medical guidelines and procedures for protection against coronavirus during the COVID-19 pandemic: a pilot study

Background: Paramedics are the frontline workers of the healthcare profession. Thus, they need to be equipped with the relevant knowledge, skills, and protective gear against different forms of infection, including coronavirus disease 2019 (COVID-19). Aim of the study: To determine the level of paramedics’ knowledge about implementing medical guidelines and procedures to avoid coronavirus infection during the COVID-19 pandemic. Material and methods: This study involved 101 paramedics employed in Emergency Medical Services in Legnica between November 2020 and January 2021. A diagnostic survey method and opinion polling technique were applied. A survey developed by the study authors was used. Results: Overall, 38 (37.62%) paramedics had sufficient knowledge of medical guidelines and procedures preventing coronavirus infection, 28 (27.72%) had good knowledge, 23 (22.77%) had very good knowledge, and 12 (11.88%) had insufficient knowledge of the topic. Variables such as education (p=0.305), participation in any course on COVID-19 (p=0.650), frequency of emergency services for patients suspected to have COVID-19 infection or with confirmed COVID-19 infection (p=0.116), and job seniority (p=0.984) did not have a significant influence on interviewees’ knowledge of this topic. Conclusions: There is a need for organizing courses, workshops, or training events for paramedics concerning the code of conduct and good practice while working with patients who suffer from highly infectious diseases in order to improve safety in the work environment. It is particularly important as paramedics themselves opted to organize such courses. It is recommended that before organizing the course, one should obtain information from potential participants about the preferred format of the course.

Cytotoxin antibody-based colourimetric sensor for field-level differential detection of elapid among big four snake venom

Development of a rapid, on-site detection tool for snakebite is highly sought after, owing to its clinically and forensically relevant medicolegal significance. Polyvalent antivenom therapy in the management of such envenomation cases is finite due to its poor venom neutralization capabilities as well as diagnostic ramifications manifested as untoward immunological reactions. For precise molecular diagnosis of elapid venoms of the big four snakes, we have developed a lateral flow kit using a monoclonal antibody (AB1; IgG1 – κ chain; Kd: 31 nM) generated against recombinant cytotoxin-7 (rCTX-7; 7.7 kDa) protein of the elapid venom. The monoclonal antibody specifically detected the venoms of Naja naja (p < 0.0001) and Bungarus caeruleus (p<0.0001), without showing any immunoreactivity against the viperidae snakes in big four venomous snakes. The kit developed attained the limit of quantitation of 170 pg/μL and 2.1 ng/μL in spiked buffer samples and 28.7 ng/μL and 110 ng/μL in spiked serum samples for detection of N. naja and B. caeruleus venoms, respectively. This kit holds enormous potential in identification of elapid venom of the big four snakes for effective prognosis of an envenomation; as per the existing medical guidelines.

Perioperative use of intra-articular steroids during the COVID-19 pandemic

Purpose There are growing concerns with the widely used glucocorticoids during the Coronavirus disease-19 (COVID-19) pandemic due to the associated immunosuppressive effects, which may increase the risk of COVID-19 infection and worsen COVID-19 patient outcome. Heavily affecting orthopaedics, the pandemic led to delay and cancellation of almost all surgical cases, and procedures including perioperative intra-articular corticosteroid injections (ICIs) saw similar decreases. However, the benefits of ICI treatments during the pandemic may outweigh these potential risks, and their continued use may be warranted. Methods A literature search was conducted, and all relevant articles including original articles and reviews were identified and considered in full for inclusion, and analysed with expert opinion. Epidemiological statistics and medical guidelines were consulted from relevant authorities. Results ICIs allow a targeted approach on the affected joint and are effective in reducing pain while improving functional outcome and patient quality-of-life. ICIs delay the requirement for surgery, accommodating for the increased healthcare burden during the pandemic, while reducing postoperative hospital stay, bringing significant financial benefits. However, ICIs can exert systemic effects and suppress the immune system. ICIs may increase the risk of COVID-19 infection and reduce the efficacy of COVID-19 vaccinations, leading to important public health implications. Conclusion Perioperative ICI treatments may bring significant, multifaceted benefits during the pandemic. However, ICIs increase the risk of infection, and perioperative COVID-19 is associated with mortality. The use of ICIs during the COVID-19 pandemic should therefore be considered carefully on an individual patient basis, weighing the associated risks and benefits.

Caste in the Time of the COVID-19 Pandemic

Historically, it is a glaring fact that any disaster or pandemic made the Dalit and Adivasi as the worst victim. Therefore, it is of utmost importance to unfold the caste dynamics and social realities around the debate of the COVID-19 pandemic. A unique feature of India’s caste system is in its flexibility. Therefore, even during the time of the COVID-19 pandemic, the prescribed medical guidelines of ‘social distancing’ encourages the Savarnas to strengthen the caste prejudices in the name of science. Apart from this, the prescribed guidelines for ‘social distancing’ and ‘home quarantine’ exposed the graded caste inequality in India. The empirical evidence from this study brings it to the forefront that a graded caste inequality persists in household’s availability of exclusive room with attached toilet facilities and adequate ventilation facilities, household’s access to exclusive drinking water source, household’s affordability in practising hand wash with soap or detergent, etc. Therefore, when the Forward caste become the most privileged in maintaining the home quarantine and complete isolation, it becomes an unaffordable luxury for the Dalits. It makes the Dalits most vulnerable during this pandemic. Therefore, this pandemic provides a stark example of the pervasiveness and perniciousness of social inequality in India.